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Eye Scans Assess MS, Cast Doubt On Its Cause

October 18, 2012
Written by: , Filed in: Diagnostic Imaging, Neuroradiology
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Optical coherence tomography seems to be the hot new imaging modality. The latest evidence: a pair of studies that used OCT to assess the progression of multiple sclerosis and the amount of brain damage associated with it.

The studies also call into question our understanding of what causes MS.

Peter Calabresi, MD, led the studies. He’s a professor of neurology at the Johns Hopkins University School of Medicine in Baltimore and director of the Johns Hopkins Multiple Sclerosis Center.

“The eye is the window into the brain,” Dr. Calabresi said, “and by measuring how healthy the eye is, we can determine how healthy the rest of the brain is.” He was quoted in a Johns Hopkins news release.

He continued:

Eye scans are not that expensive, are really safe, and are widely used in ophthalmology, and now that we have evidence of their predictive value in MS, we think they are ready for prime time.

Dr. Calabresi and his team used OCT software they developed (and which will soon be available commercially) that can assess the layers of the light-sensitive retinal tissue—at, he said, a 10th of the cost of an MRI.

In a study published online earlier this month in The Lancet Neurology, the researchers used OCT to measure inflammation of the inner nuclear layer of the retina, comparing 164 MS patients with 60 subjects who did not have the disease. Subjects also received MRI to measure brain inflammation.

The more inflammation found in the retinas of the MS patients, the more inflammation found in their brains. Thus, the researchers said, retinal scans could be used to assess MS-related brain damage and the general progression of the disease.

The second study was also published online in October, this time in Archives of Neurology. The researchers again used both OCT eye scans and MRI brain scans on MS patients and healthy controls, focusing on two other deep retinal layers. The more cell wasting they found in those layers, the greater the atrophy in the gray matter of the brain, indicating MS-related brain damage.

Again, Dr. Calabresi said, researchers could use eye scans as an indicator of brain damage to help guide MS treatment.

The findings also made him wonder about the prevailing theory that MS occurs when the immune system attacks the myelin sheaths that protect the nerves. There is no myelin deep in the retina. So if MS causes damage there, perhaps the immune system is targeting something else in addition to myelin, he said:

It is really important to know what the immune system is attacking. The treatments we have right now are only moderately effective, so maybe we’re not blocking the right kinds of cells.

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