Editors' note: Optical coherence tomography for diagnosing optic neuritis: Are we there yet?

Abstract

In the editorial “Optical coherence tomography for diagnosing optic neuritis: Are we there yet?,” Drs. Saidha and Naismith discussed the potential application of optical coherence tomography (OCT) in providing objective support for previous optic neuritis (ON) and in highlighting the research article by Drs. Xu et al. entitled “Optical coherence tomography is highly sensitive in detecting prior optic neuritis.” In a reader response, Dr. Avasarala highlights several potential issues hindering the use of OCT in this context, including the cost of OCT hardware, continually changing algorithms for retinal segmentation, and the paucity of data on OCT's performance relative to pattern shift visual evoked responses (VEPs), a relatively older test. He also notes that an earlier publication by Naismith et al. found that OCT was less sensitive than VEP in detecting subclinical previous ON. Replying to these comments, Drs. Saidha and Naismith note that this previous study used older third-generation time domain OCT and that current fourth-generation spectral domain OCT has a much higher resolution. They cite the excellent reliability and reproducibility of key OCT measures and note that they provide useful information about the global multiple sclerosis disease process. They also argue that OCT and VEP are better viewed as complementary measures of structure and function, respectively. This is especially true because VEP has its limitations too, including distinguishing inner retinal processes from optic nerve ones. Drs. Saidha and Naismith also speculate that the use of OCT in diagnosing acute ON may also become more apparent, given the frequent thickening of the retinal nerve fiber layer during acute ON. As OCT technology continues to evolve, its clinical applications are likely to be further clarified and expanded in the coming years. In the editorial “Optical coherence tomography for diagnosing optic neuritis: Are we there yet?,” Drs. Saidha and Naismith discussed the potential application of optical coherence tomography (OCT) in providing objective support for previous optic neuritis (ON) and in highlighting the research article by Drs. Xu et al. entitled “Optical coherence tomography is highly sensitive in detecting prior optic neuritis.” In a reader response, Dr. Avasarala highlights several potential issues hindering the use of OCT in this context, including the cost of OCT hardware, continually changing algorithms for retinal segmentation, and the paucity of data on OCT's performance relative to pattern shift visual evoked responses (VEPs), a relatively older test. He also notes that an earlier publication by Naismith et al. found that OCT was less sensitive than VEP in detecting subclinical previous ON. Replying to these comments, Drs. Saidha and Naismith note that this previous study used older third-generation time domain OCT and that current fourth-generation spectral domain OCT has a much higher resolution. They cite the excellent reliability and reproducibility of key OCT measures and note that they provide useful information about the global multiple sclerosis disease process. They also argue that OCT and VEP are better viewed as complementary measures of structure and function, respectively. This is especially true because VEP has its limitations too, including distinguishing inner retinal processes from optic nerve ones. Drs. Saidha and Naismith also speculate that the use of OCT in diagnosing acute ON may also become more apparent, given the frequent thickening of the retinal nerve fiber layer during acute ON. As OCT technology continues to evolve, its clinical applications are likely to be further clarified and expanded in the coming years.