The use of optical coherence tomography in neurology: a review

Optical coherence tomography is a non-invasive, cost-efficient technique that provides high-resolution in vivo imaging of retinal tissue. The peripapillary retinal nerve fibre layer and macular ganglion cell complex are surrogate markers of neuroaxonal integrity in not only the eye, but also the CNS. Retinal atrophy may occur in tandem with CNS pathologies as a result of injury to ganglion cells, direct degeneration of the pregeniculate pathway, or retrograde trans-synaptic degeneration secondary to postgeniculate lesions. In this review, we outline the basic principles of optical coherence tomography and discuss its application to managing patients with demyelinating disorders, idiopathic intracranial hypertension, stroke, neurodegenerative conditions, and mitochondrial disorders. We demonstrate that measurements of peripapillary retinal nerve fibre layer and macular ganglion cell complex thickness are paramount in diagnosing and monitoring neurological disorders, including those with subclinical disease progression.