The purpose of this study is to assess the association between macular volume reduction (MVR) and visual as well as neurological dysfunction in multiple sclerosis (MS) patients using optical coherence tomography (OCT). Additionally, we explore the utility of OCT in monitoring neurodegeneration in patients with and without optic neuritis (ON). This prospective observational study included 10 patients with relapsing-remitting MS (RRMS, diagnosed according to the 2017 McDonald criteria) who underwent comprehensive neuroophthalmological evaluations. Neurological disability was assessed using the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS). Ophthalmological examination included SD-OCT imaging, which measured peripapillary RNFL thickness, GCL thickness, and ultimately, MVR. Moreover, patients were divided into two groups: those with and without a history of ON. The primary endpoints were the correlation of MVR with visual acuity, RNFL and GCL thinning, and its association with neurological disability as measured by EDSS and MSSS scores. All 10 patients demonstrated increased MVR, greater values observed in patients with a history of ON. A strong inverse correlation was found between MVR and visual acuity (P<0.001), indicating that as MVR increased (i.e.: macular volume decreased), visual acuity declined. Furthermore, MVR was also inversely correlated with neurological dysfunction, as measured by EDSS (P=0.003, r=0.35) and MSSS scores (P=0.01, r=-0.30), suggesting that retinal thinning indicates more severe neurological disability. Importantly, patients without ON also showed macular volume loss, although less pronounced than in those with ON, highlighting that neurodegeneration occurs in MS independently of optic neuritis.This study shows that MVR inversely correlates with visual impairment and neurological dysfunction in RRMS patients. Retinal changes reflect CNS neuro-degeneration and may serve as a predictive biomarkers for monitoring MS morbidity and recovery. Future studies may use OCT to feasibly monitor such changes in other neuro-degenerative diseases as well.