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OCT – Neuro-Axonal Loss Biomarker in MS — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationOCT – Neuro-Axonal Loss Biomarker in MSSCE Neurology

A 40-year-old woman with MS has bilateral optic nerve pallor on fundoscopy. Her visual acuity is 6/12 bilaterally. OCT shows thinning of the peripapillary RNFL and macular ganglion cell layer. She has no current optic neuritis. What does this pattern indicate in the context of MS?

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Correct answer: E — Chronic axonal loss — retinal neuro-axonal degeneration reflecting both prior optic neuritis damage and subclinical progressive neurodegeneration; OCT measures are increasingly used as biomarkers of neurodegeneration in MS

OCT measures of RNFL and ganglion cell layer (GCL) thickness are biomarkers of neuro-axonal loss in MS. Thinning reflects: (1) retrograde axonal degeneration from prior optic neuritis, (2) subclinical progressive neurodegeneration (which occurs even without clinical ON). OCT correlates with brain atrophy, EDSS, and visual function. It is increasingly used in clinical trials and practice to monitor neurodegeneration. A: Chronic thinning indicates degeneration, not active inflammation. C: The pattern and degree are pathological. D: Different distribution from glaucoma. E: Papilloedema causes thickening, not thinning.

Reference: NICE NG100 MS; Petzold et al. OCT Consensus; APOSTEL Guidelines