IGS 2026: Considering OCT in neuro-ophthalmology and neurological diseases

At the 2nd International Glaucoma Symposium in Mainz, Germany, on 31 January 2026, optical coherence tomography (OCT) and its role in glaucoma and neuro-ophthalmic disease took centre stage in a presentation by Prof. Dr. med. Wolf A. Lagrèze of the University Medical Center Freiburg.¹

Lagrèze explained that OCT should be regarded as one diagnostic tool within a broader clinical framework rather than a standalone solution. He noted that OCT “has to be regarded as one diagnostic tool, which is part of a spectrum” that also includes fundoscopy, fundus photography, perimetry, visual acuity testing, pupillary assessment, and careful history taking. In glaucoma, OCT is particularly valuable for monitoring disease progression, which he described as “the mainstay in glaucoma.”

When addressing differential diagnosis, Lagrèze said that distinguishing glaucomatous optic atrophy from optic neuropathies caused by other diseases is often straightforward for experienced clinicians. He observed that the glaucomatous optic disc has a characteristic appearance and commented, “Honestly, you don’t need an OCT for that.” In this context, OCT is not essential if careful fundus examination and clinical evaluation are performed. However, he added that OCT can be helpful in specific situations, such as differentiating glaucoma from optic disc drusen, particularly using enhanced depth imaging to visualise deeper structures of the optic nerve head.

OCT beyond glaucoma: Caution in neuro-ophthalmic interpretation

Regarding neurological disease, Lagrèze cautioned against the use of OCT as a disease-specific biomarker. He noted that there is “no specific fingerprint” on OCT for common neurodegenerative conditions such as Alzheimer’s disease or multiple sclerosis. Although OCT cannot identify specific neurological diagnoses on an individual basis, it is highly useful for detecting subtle papilloedema, allowing objective assessment of disc swelling associated with raised intracranial pressure.

Lagrèze highlighted important limitations of OCT, particularly the risk of misinterpretation when findings are considered in isolation. He cautioned that reliance on single parameters, such as inter-eye differences in retinal nerve fibre layer or ganglion cell layer thickness, may lead to false-positive diagnoses, especially in the context of revised multiple sclerosis criteria. He noted that OCT interpretation should always take into account refraction, ocular comorbidities such as glaucoma, and full clinical history.

Looking to the future, Lagrèze described OCT as “a super helpful tool,” particularly when combined with artificial intelligence (AI). He noted the potential of AI to analyse large datasets and support earlier disease detection, while emphasising the need for specificity to avoid harmful false diagnoses. He concluded by underscoring the importance of close collaboration between neurologists and ophthalmologists to ensure accurate interpretation and safe clinical application of OCT.

Reference

1. Lagrèze W. Non-glaucomatous optic neuropathies – OCT in neuro-ophthalmology and neurological diseases. Presented at: 2nd International Glaucoma Symposium; 31 January 2026; Mainz, Germany.