Advanced retinal imaging faces significant technical barriers when monitoring neurological disease progression, potentially compromising clinical decision-making for patients who need it most. This reality becomes particularly problematic for conditions like neuromyelitis optica spectrum disorders, where visual pathway damage often coincides with the need for precise retinal measurements to track disease activity.
Analysis of over 3,000 optical coherence tomography scans from 539 patients across 22 international centers revealed substantial quality control challenges. Severely vision-impaired eyes showed rejection rates of 28.9% for peripapillary scans and 41.6% for macular scans, compared to just 10.7% and 14.6% respectively in eyes with better vision. Overall, approximately one in six scans failed quality standards using established OSCAR-IB criteria across three major OCT platforms.
These findings expose a critical blind spot in neurological monitoring protocols. OCT has emerged as a valuable biomarker for tracking neuroaxonal damage in conditions affecting the visual pathway, offering non-invasive insights into disease progression. However, the technology appears least reliable precisely when patients have the most advanced disease requiring careful monitoring. The higher failure rates in macular versus peripapillary scanning (20.1% vs 14.5%) suggest anatomical factors compound the technical challenges. This represents more than a technical inconvenience—failed scans can delay treatment adjustments and compromise longitudinal disease tracking. The international scope of these quality issues indicates they transcend individual center expertise or equipment variations, pointing toward fundamental limitations in current OCT technology when applied to severely compromised visual systems.