Using a technology called optical coherence tomography (OCT), which functions like an MRI for the retina and optic nerve, Al-Louzi can detect MS lesions that an MRI can miss.
"The optic nerves are very small and difficult to image," Al-Louzi said. "Detecting lesions there can help us clinch an MS diagnosis, especially in patients who are relatively early on in their disease course."
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Optical coherence tomography captures 3D images of patients' retinal layers, including the ganglion cell layer, which sends visual information to the brain.
"Shrinking of the ganglion cell layer often mirrors overall brain degeneration, and occurs in 70% to 80% of MS patients," Al-Louzi said. "This is why ganglion imaging could also help us improve diagnosis."
Retinal imaging could also help indicate how well a patient is responding to treatment.
Al-Louzi is continuing to study the role of OCT, along with a related technique called optical coherence tomography angiography (OCTA), as a way to understand how MS affects the blood vessels in the retina.
"Our lab is collaborating with Dr. Kaisey to compare the vascular fingerprint of MS in the retina to that of other brain conditions involving blood vessels, such as migraine or small vessel disease, to see whether retinal vessels can help us distinguish between these different conditions," Al-Louzi said.
While ocular nerve and retinal imaging is important to evaluate in MS patients, it is not yet widely available in practice. Al-Louzi hopes his research will help change the standard of diagnostic care.
"I think failing to use these imaging techniques is a missed opportunity," said Al-Louzi. "Our hope is that these tests will become widespread and shorten the time between symptom onset and getting the right diagnosis."
Seeing patients wrongly diagnosed with MS, and MS patients who have gone undiagnosed, drives these physicians to keep working toward better solutions.
"I didn't really intend to go into this line of research, but being in clinic every day and seeing these problems firsthand, I just had to do something about them," Kaisey said. "Almost 1 million people in the U.S. alone live with MS. Fortunately, these imaging techniques could offer an invaluable solution."
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