Clinical Utility and Practical Challenges of OCT in the 2024 McDonald Criteria for MS: Rachel Kenney, PhD

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"Despite the challenges—with proper training, understanding of quality control, and comprehensive evaluation of both the retina and the whole person—OCT is an excellent tool. It’s highly sensitive, easy on the patient, and cost-effective. We know that patients with MS are highly affected by visual dysfunction, so this is going to be an excellent addition to the diagnostic criteria. "

Optical coherence tomography (OCT) has emerged as a key neuro-ophthalmic tool in the evaluation of patients with suspected multiple sclerosis (MS), particularly for detecting optic nerve involvement. With the incorporation of the optic nerve as a fifth lesion site in the 2024 revisions to the McDonald criteria, there is growing interest in how OCT-derived metrics, such as peripapillary retinal nerve fiber layer and macular ganglion cell layer thickness, can serve as objective evidence of neuroaxonal injury in the visual pathway. As clinicians seek earlier and more accurate diagnosis of MS, understanding the strengths, limitations, and practical implementation of OCT has become increasingly important in routine care.

At the recently concluded 2026 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 27-29, Charlotte, North Carolina, epidemiologist Rachel Kenney, PhD, an assistant professor the Departments of Neurology and Population Health at NYU Grossman School of Medicine, presented on the role of OCT in the updated 2024 McDonald criteria. Her presentation focused on how specific intereye asymmetry thresholds, on the order of 5 to 6 microns in the peripapillary retinal nerve fiber layer and approximately 4 microns in the macular ganglion cell layer, may provide supportive evidence of optic nerve injury that can contribute to the diagnostic workup for MS.

In an interview with NeurologyLive^®, Kenney discussed how OCT can be integrated into clinical practice as a relatively easy, noninvasive, and cost-effective imaging modality that offers micron-level resolution beyond what is typically achievable with conventional MRI. She highlighted the technology’s ability to detect both acute changes in patients with or without a clear history of optic neuritis. Kenney also underscored key challenges to broader adoption, including the need for standardized acquisition protocols, rigorous quality control, and appropriate training for both technicians and clinicians. Importantly, she emphasized the necessity of ruling out alternative causes of retinal asymmetry before attributing OCT findings to MS-related disease activity

Click here for more coverage of CMSC 2026.

REFERENCES
1. Kenney R. OCT in the 2024 McDonald Criteria. Presented at: 2026 CMSC Annual Meeting; May 27-29; Charlotte, North Carolina. OCT Across the Spectrum of Demyelinating Disease.