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Eyes on the Future

New research will help assess the course and treatment of MS Could the health of the optic nerve - that small bundle of fibers that carries visual messages from the eye to the brain - indicate how a person with MS is doing overall?

Eye Exam

Dr. Eugene May and OCT
equipment benefactor
Janet Pauli

Research by two Seattle neuro-ophthalmologists, Eugene May and Steve Hamilton, could help answer that question. Drs. May and Hamilton have applied to participate in a national study involving OCT, or Ocular Coherence Tomography, a relatively new eye test that measures the health of the optic nerve.

A generous donation to the Chapter from Janet Levy Pauli and Bill Pauli is being used towards the purchase the OCT equipment that will make the Seattle research possible. OCT, which has been used for other eye conditions for several years, is a simple and painless test that shines an infrared light into the patient’s eye, creating a picture of the surface of the back of the eye and measuring the thickness of the optic nerve. Optic neuritis or inflammation of the optic nerve is a common and early indicator of MS. Up to 80 percent of people with relapsing remitting MS have had optic neuritis, and it’s the first symptom in 20 to 50 percent of those diagnosed with the disease. OCT, therefore, could be an easy way of determining how someone with MS is doing and responding to treatment, Dr. May says.

Unlike other less sensitive tests, OCT can detect the loss of axons, or the thread-like extensions from nerve cells that transmit impulses. This is significant, Dr. May explains, because axon loss, not myelin damage, is what causes MS to progress.

OCT has already led to a few discoveries, including:

  • When MS affects one eye, it often affects the other, even though the patient may only experience visual problems in one eye.
  • MS patients who have never had optic neuritis sometimes have a thinner-than-normal layer of nerve fibers in their retina (the light-sensitive membrane in the back of the eye that receives images).

“The optic nerve technically is a part of the brain,” Dr. May says. “So this test may indicate the health of their brain.” Right now, it can be very difficult to determine how a patient is faring or responding to treatment because the disease is so variable, he says.

Dr. May, the Paulis, Dr. Hamilton

Neuro-ophthalmologists Dr. Eugene May (left)
and Dr. Steven Hamilton (right) thank donors
Janet and Bill Pauli

OCT isn’t likely to replace MRI scans, but it could become one of many tools that neurologists can use to track people with MS, Dr. May adds. “There may be some patients for whom OCT will be a very sensitive indicator of disease activity. Only further research will tell.” The national study is scheduled to start in December. The Seattle research is expected to involve five patients with optic neuritis over the course of a year. Some patients will be treated for MS and some will receive a placebo. They will be monitored over the course of the study with OCT and MRI scans. The study will look at which patients go on to develop MS and which don’t, as well as whether the changes in their optic nerve correlate with changes seen in their MRIs. The resulting data also could help prove whether those who start MS treatments early in the course of their disease are ultimately better off.

Research already has shown that drugs for MS can change the course of the disease. In the last 15 to 20 years, he says, “we’ve found that early treatment with these medications may very well have a profound effect on the long-term outcome of people with MS.”

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