Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system (CNS) with inflammatory demyelinating lesions and neuronal loss that is clinically characterised by unpredictable clinical relapses, remissions and progression of disability over time.^1–3 Damage occurs to the myelin sheath that surrounds and protects nerve cells; this slows down or blocks messages between the brain and the body, leading to the symptoms of MS. The disease usually begins with one or more clinically isolated syndrome (CIS) leading to a relapsing– remitting phase (RRMS) that is accompanied by a varying degree of impairment.² After 10–15 years, approximately 50% of these patients advance to the secondary progressive form of the disease, which is characterised by a slow but progressive decline in performance with or without superimposed relapses.^4,5 Approximately 10–15% of MS patients show progression from the onset (primary progressive MS [PPMS]).^6,7 Symptoms are highly heterogeneous from one patient to another. More recently, our attention has been focused on the nonphysical symptoms such as fatigue and cognitive symptoms.^8–11

Despite significant advances in treatment, MS remains a highly disabling disease, and in many cases significantly reduces life expectancy.¹² Recent studies have shown that initiating treatment early with a disease-modifying drug, possibly during CIS, can provide significant advantages over delaying it until symptoms are more apparent. This has generated much interest and has modified treatment practices in MS.^13,14 However, some neurologists have questioned the long-term benefit of treating everyone with CIS, suggesting that in some cases the disease will not progress and that greater investigation of patients is warranted before starting more appropriately tailored therapies.¹⁵ Acute idiopathic demyelinating optic neuritis (ON) is a frequent early manifestation of MS that is often indicative of early disease and can be predictive of later progressive stages.¹⁶ Optical coherence tomography (OCT) is an evolving technique that has the potential not only to diagnose ON but also to provide a valuable assessment of MS.¹⁷ This review will consider the evidence for using OCT in patientswith ON and its potential role as a tool for routinely monitoring MS.

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