Materiały źródłowe

• #1 The Diagnosis and Treatment of Optic Neuritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4581115/

  Typical optic neuritis is often the presenting manifestation of multiple sclerosis (MS). The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. In unilateral optic neuritis, the direct pupillary light reflex is weaker in the affected eye. The visual disturbance resolves in 95% of cases. High-dosed intravenous methylprednisolone therapy speeds recovery but does not improve the final outcome. The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. Optic neuritis is easy to distinguish from other diseases affecting the optic nerve. The clinical constellation of pain on eye movement, a relative afferent pupillary defect, and a normal or mildly edematous optic disc is pathognomonic for optic neuritis and suffices to establish the diagnosis. Unclear time of onset, lack of pain on eye movement, and lack of improvement of the visual deficit over time largely rule out optic neuritis. The task of the ophthalmologist is to provide objective evidence for the diagnosis. The optic disc usually appears normal but is mildly edematous in one-third of cases. The clinical history is important for the diagnosis of optic neuritis. The incidence of optic neuritis in central Europe is 5 cases per 100 000 persons per year. The mean age at onset is 36 years; it is rare in persons under 18 or over 50. The affected eye is blind in 3% of cases but has an acuity of 1.0 or better in 11% of cases. The diagnosis of multiple sclerosis requires the demonstration of inflammatory lesions in the central nervous system that are disseminated in both space and time. The Optic Neuritis Treatment Trial yielded precise figures on the risk of developing multiple sclerosis. Half of all patients with typical optic neuritis will develop multiple sclerosis within 15 years.

• #2 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  Optic neuritis is a vision-threatening disorder and often the first symptom of demyelinating diseases such as multiple sclerosis. […] Diagnosis involves a thorough clinical evaluation and the use of advanced imaging modalities, particularly optical coherence tomography and magnetic resonance imaging. […] Diagnosis of optic neuritis involves both clinical evaluation and imaging studies. Magnetic resonance imaging (MRI) of the brain and orbits with gadolinium contrast is the imaging modality of choice. MRI can help visualize optic nerve inflammation and detect any demyelinating plaques in the brain, which may indicate a high risk for multiple sclerosis. […] The mainstay of treatment for optic neuritis is high-dose corticosteroids, typically administered intravenously for a short course, followed by an oral taper.

• #3 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  Optic neuritis (ON) is an inflammatory condition of the optic nerve that is commonly seen in central nervous system demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-related diseases. […] The diagnosis of optic neuritis (inflammation of the optic nerve) is usually made clinically, with direct imaging of the optic nerves by magnetic resonance imaging (MRI) being reserved for atypical cases. […] MRI of the brain provides information that can change the management of optic neuritis and yields prognostic information regarding the patient’s future risk for the development of multiple sclerosis. […] As established by the Optic Neuritis Treatment Trial, an abnormal baseline brain MRI scan is a strong predictor of MS after isolated optic neuritis in adults.

• #4 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  You’re likely to see an ophthalmologist for a diagnosis, which is generally based on your medical history and an exam. The ophthalmologist likely will perform the following eye tests: […] A routine eye exam. Your eye doctor will check your vision and your ability to perceive colors and measure your side (peripheral) vision. […] Ophthalmoscopy. During this examination, your doctor shines a bright light into your eye and examines the structures at the back of your eye. This eye test evaluates the optic disk, where the optic nerve enters the retina in your eye. The optic disk becomes swollen in about one-third of people with optic neuritis. […] Pupillary light reaction test. Your doctor may move a flashlight in front of your eyes to see how your pupils respond when they’re exposed to bright light. If you have optic neuritis, your pupils won’t constrict as much as pupils in healthy eyes would when exposed to light.

• #5 The Diagnosis and Treatment of Optic Neuritis (11.09.2015)

  https://di.aerzteblatt.de/int/archive/article/171815

  The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. […] The clinical constellation of pain on eye movement, a relative afferent pupillary defect, and a normal or mildly edematous optic disc is pathognomonic for optic neuritis and suffices to establish the diagnosis. […] The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. […] The diagnosis of multiple sclerosis requires the demonstration of inflammatory lesions in the central nervous system that are disseminated in both space and time. […] According to the revised McDonald criteria (2011), multiple sclerosis can be diagnosed when the MRI in a patient with optic neuritis reveals two or more typical lesions of multiple sclerosis, at least one of which is contrast-enhancing.

• #6 The Diagnosis and Treatment of Optic Neuritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4581115/

  Typical optic neuritis is often the presenting manifestation of multiple sclerosis (MS). The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. In unilateral optic neuritis, the direct pupillary light reflex is weaker in the affected eye. The visual disturbance resolves in 95% of cases. High-dosed intravenous methylprednisolone therapy speeds recovery but does not improve the final outcome. The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. Optic neuritis is easy to distinguish from other diseases affecting the optic nerve. The clinical constellation of pain on eye movement, a relative afferent pupillary defect, and a normal or mildly edematous optic disc is pathognomonic for optic neuritis and suffices to establish the diagnosis. Unclear time of onset, lack of pain on eye movement, and lack of improvement of the visual deficit over time largely rule out optic neuritis. The task of the ophthalmologist is to provide objective evidence for the diagnosis. The optic disc usually appears normal but is mildly edematous in one-third of cases. The clinical history is important for the diagnosis of optic neuritis. The incidence of optic neuritis in central Europe is 5 cases per 100 000 persons per year. The mean age at onset is 36 years; it is rare in persons under 18 or over 50. The affected eye is blind in 3% of cases but has an acuity of 1.0 or better in 11% of cases. The diagnosis of multiple sclerosis requires the demonstration of inflammatory lesions in the central nervous system that are disseminated in both space and time. The Optic Neuritis Treatment Trial yielded precise figures on the risk of developing multiple sclerosis. Half of all patients with typical optic neuritis will develop multiple sclerosis within 15 years.

• #7 Demyelinating Optic Neuritis – EyeWiki

  https://eyewiki.org/Demyelinating_Optic_Neuritis

  MRI of the brain is helpful after an initial episode of ON because the number of lesions seen can stratify the patients risk for developing clinically definite (CD) multiple sclerosis (MS) after a clinically isolated syndrome (CIS). […] ON is a clinical diagnosis that is made when a patient presents with: Unilateral (but may be bilateral) decreased visual acuity, Pain with eye movement and/or periorbital discomfort, RAPD if unilateral or bilateral and asymmetric, Visual field defect (nerve fiber layer or central loss), Normal-appearing fundus (retrobulbar ON) although optic nerve swelling can be seen in up to 35% of cases. […] ON is diagnosed clinically by symptoms of acute unilateral decrease in vision, eye pain (especially with movement), RAPD (in unilateral or bilateral asymmetric cases), decreased color vision/contrast/brightness sense and a visual field defect.

• #8 The Diagnosis and Treatment of Optic Neuritis (11.09.2015)

  https://di.aerzteblatt.de/int/archive/article/171815

  The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. […] The clinical constellation of pain on eye movement, a relative afferent pupillary defect, and a normal or mildly edematous optic disc is pathognomonic for optic neuritis and suffices to establish the diagnosis. […] The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. […] The diagnosis of multiple sclerosis requires the demonstration of inflammatory lesions in the central nervous system that are disseminated in both space and time. […] According to the revised McDonald criteria (2011), multiple sclerosis can be diagnosed when the MRI in a patient with optic neuritis reveals two or more typical lesions of multiple sclerosis, at least one of which is contrast-enhancing.

• #9 The Diagnosis and Treatment of Optic Neuritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4581115/

  Typical optic neuritis is often the presenting manifestation of multiple sclerosis (MS). The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. In unilateral optic neuritis, the direct pupillary light reflex is weaker in the affected eye. The visual disturbance resolves in 95% of cases. High-dosed intravenous methylprednisolone therapy speeds recovery but does not improve the final outcome. The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. Optic neuritis is easy to distinguish from other diseases affecting the optic nerve. The clinical constellation of pain on eye movement, a relative afferent pupillary defect, and a normal or mildly edematous optic disc is pathognomonic for optic neuritis and suffices to establish the diagnosis. Unclear time of onset, lack of pain on eye movement, and lack of improvement of the visual deficit over time largely rule out optic neuritis. The task of the ophthalmologist is to provide objective evidence for the diagnosis. The optic disc usually appears normal but is mildly edematous in one-third of cases. The clinical history is important for the diagnosis of optic neuritis. The incidence of optic neuritis in central Europe is 5 cases per 100 000 persons per year. The mean age at onset is 36 years; it is rare in persons under 18 or over 50. The affected eye is blind in 3% of cases but has an acuity of 1.0 or better in 11% of cases. The diagnosis of multiple sclerosis requires the demonstration of inflammatory lesions in the central nervous system that are disseminated in both space and time. The Optic Neuritis Treatment Trial yielded precise figures on the risk of developing multiple sclerosis. Half of all patients with typical optic neuritis will develop multiple sclerosis within 15 years.

• #10 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  You’re likely to see an ophthalmologist for a diagnosis, which is generally based on your medical history and an exam. The ophthalmologist likely will perform the following eye tests: […] A routine eye exam. Your eye doctor will check your vision and your ability to perceive colors and measure your side (peripheral) vision. […] Ophthalmoscopy. During this examination, your doctor shines a bright light into your eye and examines the structures at the back of your eye. This eye test evaluates the optic disk, where the optic nerve enters the retina in your eye. The optic disk becomes swollen in about one-third of people with optic neuritis. […] Pupillary light reaction test. Your doctor may move a flashlight in front of your eyes to see how your pupils respond when they’re exposed to bright light. If you have optic neuritis, your pupils won’t constrict as much as pupils in healthy eyes would when exposed to light.

• #11

  https://www.aao.org/eye-health/diseases/what-is-optic-neuritis

  Optic neuritis diagnosis involves a thorough examination by your ophthalmologist. […] Your ophthalmologist will check your eyes thoroughly and do the following things: […] Check to see if your optic nerve is swollen by looking inside your eye with an instrument called an ophthalmoscope. […] Test your side (peripheral) vision. […] Test to check how well you see colors. […] Check to see how your pupils respond to light. […] Your ophthalmologist may also want certain tests to show detailed images of your visual system. They could include a CT scan, MRI scan or visual brain wave recording (which shows how your brain processes visual information).

• #12 Moran CORE | Optic Neuritis–How to assess for optic neuritis and ddx

  https://morancore.utah.edu/section-05-neuro-ophthalmology/optic-neuritis-how-to-assess-for-optic-neuritis-and-ddx/

  Optic neuritis is inflammation of the optic nerves that can be caused by a variety of conditions including demyelination, vasculitis, infection, granulomatous disease, other autoimmune disorders, and paraneoplastic disorders. The most common cause of optic neuritis is typical optic neuritis that may be associated with multiple sclerosis or may be idiopathic. […] According to the optic neuritis treatment trial, 64% of patients have unilateral vision loss of 20/200, and 92% have associated pain with eye movements. […] An ophthalmologic evaluation should include visual acuity, pupillary exam and careful testing for a relative afferent pupillary defect, color vision testing, red desaturation testing in each visual field, confrontation visual fields, and fundus examination to evaluate for vitreous cell, macular involvement, and severity of optic nerve edema.

• #13 Demyelinating Optic Neuritis – EyeWiki

  https://eyewiki.org/Demyelinating_Optic_Neuritis

  MRI of the brain is helpful after an initial episode of ON because the number of lesions seen can stratify the patients risk for developing clinically definite (CD) multiple sclerosis (MS) after a clinically isolated syndrome (CIS). […] ON is a clinical diagnosis that is made when a patient presents with: Unilateral (but may be bilateral) decreased visual acuity, Pain with eye movement and/or periorbital discomfort, RAPD if unilateral or bilateral and asymmetric, Visual field defect (nerve fiber layer or central loss), Normal-appearing fundus (retrobulbar ON) although optic nerve swelling can be seen in up to 35% of cases. […] ON is diagnosed clinically by symptoms of acute unilateral decrease in vision, eye pain (especially with movement), RAPD (in unilateral or bilateral asymmetric cases), decreased color vision/contrast/brightness sense and a visual field defect.

• #14 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  Optic neuritis is a vision-threatening disorder and often the first symptom of demyelinating diseases such as multiple sclerosis. […] Diagnosis involves a thorough clinical evaluation and the use of advanced imaging modalities, particularly optical coherence tomography and magnetic resonance imaging. […] Diagnosis of optic neuritis involves both clinical evaluation and imaging studies. Magnetic resonance imaging (MRI) of the brain and orbits with gadolinium contrast is the imaging modality of choice. MRI can help visualize optic nerve inflammation and detect any demyelinating plaques in the brain, which may indicate a high risk for multiple sclerosis. […] The mainstay of treatment for optic neuritis is high-dose corticosteroids, typically administered intravenously for a short course, followed by an oral taper.

• #15 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  Optic neuritis (ON) is an inflammatory condition of the optic nerve that is commonly seen in central nervous system demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-related diseases. […] The diagnosis of optic neuritis (inflammation of the optic nerve) is usually made clinically, with direct imaging of the optic nerves by magnetic resonance imaging (MRI) being reserved for atypical cases. […] MRI of the brain provides information that can change the management of optic neuritis and yields prognostic information regarding the patient’s future risk for the development of multiple sclerosis. […] As established by the Optic Neuritis Treatment Trial, an abnormal baseline brain MRI scan is a strong predictor of MS after isolated optic neuritis in adults.

• #16 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  Other tests to diagnose optic neuritis might include: […] Magnetic resonance imaging (MRI). An Magnetic resonance imaging (MRI) scan uses a magnetic field and pulses of radio wave energy to make pictures of your body. During an MRI to check for optic neuritis, you might receive an injection of a contrast solution to make the optic nerve and other parts of your brain more visible on the images. […] An MRI is important to determine whether there are damaged areas (lesions) in your brain. Such lesions indicate a high risk of developing multiple sclerosis. An MRI can also rule out other causes of visual loss, such as a tumor. […] Blood tests. A blood test is available to check for infections or specific antibodies. Neuromyelitis optica is linked to an antibody that causes severe optic neuritis. People with severe optic neuritis may undergo this test to determine whether they’re likely to develop neuromyelitis optica. For atypical cases of optic neuritis, blood may also be tested for MOG antibodies.

• #17 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  Optic neuritis (ON) is an inflammatory condition of the optic nerve that is commonly seen in central nervous system demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-related diseases. […] The diagnosis of optic neuritis (inflammation of the optic nerve) is usually made clinically, with direct imaging of the optic nerves by magnetic resonance imaging (MRI) being reserved for atypical cases. […] MRI of the brain provides information that can change the management of optic neuritis and yields prognostic information regarding the patient’s future risk for the development of multiple sclerosis. […] As established by the Optic Neuritis Treatment Trial, an abnormal baseline brain MRI scan is a strong predictor of MS after isolated optic neuritis in adults.

• #18 Diagnostic Approach to Atypical Optic Neuritis – EyeWiki

  https://eyewiki.org/Diagnostic_Approach_to_Atypical_Optic_Neuritis

  A complete dilated eye examination is recommended including formal automated perimetry for all patients with suspected ON. The Optic Neuritis Treatment Trial (ONTT) was a randomized, controlled clinical trial that defined the treatment for ON. In the ONTT, testing for etiologies other than MS was not helpful in typical ON. Cranial magnetic resonance imaging (MRI) however was helpful in defining the risk for MS. Patients suspected of having an infectious, inflammatory, or autoimmune etiology for ON however based upon atypical features in the history or examination may benefit from further testing. […] Brain and orbital MRI with contrast can confirm or exclude different forms of optic neuropathy. Typical ON demonstrates a short segment of contrast enhancement of the optic nerve and demyelinating white matter lesions for MS may be seen. Atypical ON due to NMO may show a non-MS location of white matter lesions on the brain MRI, the optic nerve enhancement may be more posterior (optic chiasm and optic tract) and there maybe longitudinally extensive enhancement (length) of the optic nerve.

• #19 Optic neuritis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/optic-neuritis?lang=us

  Optic neuritis denotes inflammation of the optic nerve and is one of the more common causes of optic neuropathy. […] On imaging, optic neuritis is most easily identified as a unilateral optic nerve swelling, with high T2 signal and contrast enhancement. […] MRI is the modality of choice for visualizing the optic nerve. […] Contrast enhancement of the nerve, best seen with fat-suppressed T1 coronal images, is seen in 90% of patients if scanned within 20 days of visual loss. […] Although there is considerable evidence that corticosteroid therapy does not alter visual outcome at six months, it does appear to hasten recovery and some trials have shown persistent improvement of contrast sensitivity, visual fields, and color vision. […] If therapy is prescribed, it is usually three or more days of high dose steroids, started as early after symptom onset as possible.

• #20 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  In atypical cases (eg, prolonged or severe pain, lack of visual recovery, atypical visual-field loss, evidence of orbital inflammation and/or inflammation), MRI is used to further characterize and to exclude other disease processes. […] The signal intensity ratio (SIR) of the optic nerve to the white matter (WM) on STIR was found to be of diagnostic value for acute optic neuritis (AON) in a study of 405 patients with suspected orbital diseases who underwent orbital MRI with a 3-T scanner. […] Optic neuritis in neuromyelitis optica was found to have a distinct pattern on MRI, as compared to relapsing-remitting multiple sclerosis. […] In a study of 31 patients with optic neuritis, 3-dimensional double inversion recovery (3D DIR) was found to provide improved detection of optic nerve signal abnormalities over 2-dimensional (2D) short tau inversion recovery (STIR) fluid-attenuated inversion recovery (FLAIR).

• #21 Optic Neuritis

  https://webeye.ophth.uiowa.edu/eyeforum/cases/159-optic-neuritis.htm

  According to the Optic Neuritis Treatment Trial (Optic Neuritis Study Group, 2008), patients with no brain lesions on MRI had a 25% risk of progression to multiple sclerosis within 15 years, as compared to a 72% risk of progression in the same time period in patients with at least one demyelinating lesion seen on MRI. […] In patients with newly diagnosed optic neuritis, the question of a diagnosis of multiple sclerosis is often raised. […] Recurring optic neuritis in the same eye or fellow eye is not uncommon, occurring in 35% of patients at 10 years according to the Optic Neuritis Treatment Trial. […] Treatment for optic neuritis is based on the Optic Neuritis Treatment Trial protocol (Beck, 1992), which used IV methylprednisolone 250 mg q 6 hours x 3 days, followed by oral prednisone 1 mg/kg/day for 11 days. […] In the case above, as is customary in our eye clinic when a patient presents with optic neuritis and has one or more typical demyelinating lesions on brain MRI, we treat based on the Optic Neuritis Treatment Trial protocol.

• #22 Optic Neuritis: Who Is At Risk for MS?

  https://www.reviewofophthalmology.com/article/optic-neuritis-who-is-at-risk-for-ms

  The presence of even one demyelinated plaque (i.e. a single 3-mm diameter white matter lesion visible on the brain MRI) placed the patient at a higher risk for MS than if lesions were absent on MRI. […] For prognostic purposes, an MRI should be done at the time of the first demyelinating event. […] The absence of certain clinical features typical of demyelinating ON, also lowered the risk of MS. […] The protocol for Solumedrol treatment has been variously modified without scientific verification of efficacy. […] The patient with typical, isolated, monosymptomatic ON should be referred promptly to a neurologist who can begin immunomodulatory medication. […] The neurologist relies on the ophthalmologist to accurately diagnose ON and to distinguish demyelinating ON from other optic neuropathies or retinal conditions that have similar symptoms.

• #23 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  Optical coherence tomography (OCT). This test measures the thickness of the eye’s retinal nerve fiber layer, which is often thinner from optic neuritis. […] Visual field test. This test measures the peripheral vision of each eye to determine if there is any vision loss. Optic neuritis can cause any pattern of visual field loss. […] Visual evoked response. During this test, you sit before a screen on which an alternating checkerboard pattern is displayed. Attached to your head are wires with small patches to record your brain’s responses to what you see on the screen. This type of test tells your doctor if the electrical signals to your brain are slower than normal as a result of optic nerve damage. […] Your doctor is likely to ask you to return for follow-up exams two to four weeks after your symptoms begin to confirm the diagnosis of optic neuritis.

• #24 From diagnosis to treatment: exploring the mechanisms underlying optic neuritis in multiple sclerosis | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-025-06105-1

  The established markers of visual impairment in patients with MS, including visual field, visual acuity, retinal nerve fiber layer (RNFL) thickness, macular volume or thickness, VEP, as well as immune cells and glial cells, can all be identified using the aforementioned techniques. […] In conclusion, LCLA provides a sensitive test for diagnosing and tracking visual impairment in MS patients. […] Optic nerve MRI aids in diagnosing visual impairment in MS by providing information about optic nerve pathology and changes in tissue histology that may not be discernible through routine visual examination. […] The latest research shows that incorporating symptomatic optic nerve involvement into Disability status scale criteria can improve the overall efficacy of MS diagnostic, specifically increasing the sensitivity of MS diagnosis from 83 to 95% and the overall accuracy from 78 to 81%.

• #25 Neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disorder-optic neuritis: a comprehensive review of diagnosis and treatment | Eye

  https://www.nature.com/articles/s41433-020-01334-8

  Gadolinium-enhanced MRI reveals optic nerve enhancement in ~94% of cases of acute ON. […] Importantly, however, extensive optic nerve involvement does not distinguish NMOSD-ON from MOGAD-ON. […] For those patients with MRI optic nerve abnormalities suspicious for NMOSD-ON, spine imaging should be performed to assess for longitudinally extensive transverse myelitis. […] The clinical suspicion for NMOSD-ON may be informed by in-office ancillary testing. […] Optical coherence tomography (OCT) is of minimal value in distinguishing NMOSD-ON from idiopathic-ON/MS-ON in the acute phase. […] The hallmark of NMOSD is a relapsing course with relentless, stepwise progression of neurological disability, including blindness. […] Treatment of acute flares of NMOSD-ON is imperative to reduce long-term visual morbidity. IVMP is the mainstay of treatment, and early treatment has been shown to correlate with preservation of pRNFL. […] The necessity of long-term immunosuppressive therapy for MOGAD is less clear-cut than in AQP4-IgG seropositive NMOSD.

• #26 Optic Neuritis: Symptoms, Causes & Treatment Options

  https://my.clevelandclinic.org/health/diseases/14256-optic-neuritis

  Optic neuritis is when inflammation in your optic nerve causes pain, vision loss and other symptoms. Timely diagnosis and treatment may help optic neuritis and limit or delay more severe long-term effects or conditions. […] An eye care specialist may suspect optic neuritis based on: Your symptoms. Your medical history. If you have (or could have) another condition that could cause optic neuritis. […] The following tests are also likely early on: Visual evoked potentials. Optical coherence tomography. […] If the above checks and test results are consistent with optic neuritis, and another condition doesn’t better explain your symptoms, your eye care provider will probably refer you to a specialist. This may be a neurologist or a neuro-ophthalmologist (an eye care specialist who focuses on retinal and optic nerve issues and conditions).

• #27 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  Optical coherence tomography (OCT). This test measures the thickness of the eye’s retinal nerve fiber layer, which is often thinner from optic neuritis. […] Visual field test. This test measures the peripheral vision of each eye to determine if there is any vision loss. Optic neuritis can cause any pattern of visual field loss. […] Visual evoked response. During this test, you sit before a screen on which an alternating checkerboard pattern is displayed. Attached to your head are wires with small patches to record your brain’s responses to what you see on the screen. This type of test tells your doctor if the electrical signals to your brain are slower than normal as a result of optic nerve damage. […] Your doctor is likely to ask you to return for follow-up exams two to four weeks after your symptoms begin to confirm the diagnosis of optic neuritis.

• #28 Optic neuritis – Wikipedia

  https://en.wikipedia.org/wiki/Optic_neuritis

  Magnetic resonance imaging (MRI) is a robust and sensitive diagnostic modality for the detection of optic neuritis. Imaging of the optic nerve with MRI shows increased signal on the affected side. […] Optical coherence tomography (OCT) is a sensitive imaging modality that can reveal subtle pathologic changes in the optic nerve and retina. […] Visual evoked potential (VEP) is a sensitive test that measures the P100 latency of axonal transmission along the optic nerve.

• #29 Adult Optic Neuritis Workup: Approach Considerations, Magnetic Resonance Imaging, Visual Evoked Potentials

  https://emedicine.medscape.com/article/1217083-workup

  MRI may have a value in predicting future development of multiple sclerosis (MS) in patients presenting with first-time, acute ON. […] Magnetic resonance imaging performed at the initial presentation reveals that 10-20% of these patients may have clinically silent demyelinated lesions elsewhere in the brain. […] Use of fat saturation techniques helps to visualize gadolinium enhancement of the optic nerve and is the best imaging technique with which to visualize inflammation of the optic nerve. […] Visual evoked potentials (VEPs) are an important means of evaluating patients with suspected optic neuritis (ON). […] Visual evoked potentials may be abnormal in patients with suspected MS without a history of ON, thereby providing evidence of subclinical involvement of the optic nerve.

• #30 Adult Optic Neuritis Workup: Approach Considerations, Magnetic Resonance Imaging, Visual Evoked Potentials

  https://emedicine.medscape.com/article/1217083-workup

  Blood tests that can be considered to rule out causes of optic neuropathy other than demyelinating optic neuritis (ON) include the following: […] In a typical patient with ON without any clinical signs or symptoms of systemic disease, however, the yield from these tests is extremely low. […] Cerebrospinal fluid (CSF) analysis is often noncontributory to diagnosis; however, the presence of myelin basic protein, oligoclonal bands, and an elevated IgG index and synthesis rate in the CSF support the diagnosis of multiple sclerosis (MS). […] Formal perimetry should be performed. Optical coherence tomography with nerve fiber layer quantification may be used to document neuroaxonal loss. […] Magnetic resonance imaging (MRI) is highly sensitive and specific in assessing inflammatory changes in the optic nerves and helps to rule out structural lesions.

• #31 Optic Neuritis Clinical Guide | Cleveland Clinic

  https://my.clevelandclinic.org/departments/neurological/depts/multiple-sclerosis/ms-approaches/optic-neuritis

  Optic neuritis (ON) is a common manifestation of multiple sclerosis (MS), and refers to inflammation of the optic nerve. It can be the initial demyelinating event in up to 20% of patients, and occurs in almost half of patients with MS. ON associated with demyelinating disease is generally characterized by acute to subacute, painful, and monocular vision loss. Vision typically worsens over hours to days (not months), and recovery is expected to begin within 1 month of symptom onset. […] The diagnosis of ON involves primarily clinical, electrophysiologic, and imaging evaluations. Clinically, patients typically describe central (less commonly arcuate, cecocentral, or hemianopic) vision loss that progresses over hours to days. Examination is commonly notable for impaired visual acuity, red desaturation, and an afferent pupillary defect. Funduscopic examination can appear normal acutely, but disc edema can be present in approximately one-third of patients (particularly those with anterior optic neuritis).

• #32 Optic neuritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/optic-neuritis/diagnosis-treatment/drc-20354958

  Optical coherence tomography (OCT). This test measures the thickness of the eye’s retinal nerve fiber layer, which is often thinner from optic neuritis. […] Visual field test. This test measures the peripheral vision of each eye to determine if there is any vision loss. Optic neuritis can cause any pattern of visual field loss. […] Visual evoked response. During this test, you sit before a screen on which an alternating checkerboard pattern is displayed. Attached to your head are wires with small patches to record your brain’s responses to what you see on the screen. This type of test tells your doctor if the electrical signals to your brain are slower than normal as a result of optic nerve damage. […] Your doctor is likely to ask you to return for follow-up exams two to four weeks after your symptoms begin to confirm the diagnosis of optic neuritis.

• #33 Diagnostic Approach to Atypical Optic Neuritis – EyeWiki

  https://eyewiki.org/Diagnostic_Approach_to_Atypical_Optic_Neuritis

  In the ONTT, additional laboratory testing (e.g., erythrocyte sedimentation rate or antinuclear antibodies, syphilis serology) were unlikely to demonstrate any true positive results in typical ON. Patients with atypical ON may benefit from additional testing. Some additional tests that might be considered include aquaporin-4 water (AQP4) antibodies or MOG antibodies. […] Atypical ON however should undergo full testing for alternative etiologies as above for an optic neuropathy and treatment should be directed to the underlying etiology. For atypical ON, corticosteroids are frequently given in the acute phase until the testing can be completed. Patients who do not respond to initial IV steroid therapy (e.g., NMO or MOG) may benefit from early plasma exchange (PLEX) or IVIG. […] The prognosis depends on the underlying etiology. In atypical ON however the prognosis depends upon the underlying etiology.

• #34 Optic neuritis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/966

  Optic neuritis (ON) may involve the retrobulbar (retrobulbar neuritis) or the intrabulbar (papillitis) portion of the optic nerve, or both. […] Investigations including MRI of the brain can help to predict the risk of conversion to MS and can dictate early intervention with disease-modifying treatments (interferon-beta, glatiramer acetate) that reduces the risk of conversion to MS. […] Acute treatment for idiopathic ON includes high-dose oral or intravenous corticosteroid treatment. […] Low-to-medium dose oral corticosteroids alone should not be used in the treatment of idiopathic acute ON. […] Key diagnostic factors include peri-orbital/retro-ocular pain, loss of visual acuity with scotoma, colour desaturation/loss of colour vision, and relative afferent papillary defect (RAPD). […] 1st investigations to order include MRI – brain, FBC, ESR, C-reactive protein, VDRL, aquaporin-4 (AQP4) antibody, myelin oligodendrocyte glycoprotein (MOG) antibody, and collapsin response mediator protein 5 (CRMP5) antibody. […] Investigations to consider include Lyme titre and cerebrospinal fluid analysis.

• #35 Optic neuritis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/966

  Optic neuritis (ON) may involve the retrobulbar (retrobulbar neuritis) or the intrabulbar (papillitis) portion of the optic nerve, or both. […] Investigations including MRI of the brain can help predict the risk of conversion to MS and can dictate early intervention with disease-modifying treatments (interferon-beta, glatiramer acetate) that reduces the risk of conversion to MS. […] Diagnostic investigations include MRI – brain, CBC, ESR, C-reactive protein, venereal disease research laboratory (VDRL), aquaporin-4 (AQP4) antibody, myelin oligodendrocyte glycoprotein (MOG) antibody, and collapsin response mediator protein 5 (CRMP5) antibody. […] Other diagnostic factors include optic disk swelling, neurologic abnormalities of multiple sclerosis, and Uhthoff phenomenon.

• #36 Optic Neuritis in the Era of Biomarkers – Insights

  https://news.mayocliniclabs.com/2019/06/03/optic-neuritis-in-the-era-of-biomarkers/

  Antibodies to aquaporin-4 and myelin oligodendrocyte glycoprotein (MOG) are recently described biomarkers seen in a subset of atypical optic neuritis which have revolutionized our understanding of optic neuritis. […] The ONTT did a wonderful job of providing guidance for cases of typical optic neuritis. However, there were cases of atypical optic neuritis that were unexplained until more recently. We now have biomarkers of optic neuritis, which are offered by the Mayo Clinic Neuroimmunology Laboratory, that help explain many cases of atypical optic neuritis, such as severe optic neuritis with poor recovery, bilateral optic neuritis, prominent disc edema, and relapsing optic neuritis. […] One question we are often asked is, when should we test for AQP4 and MOG antibodies? We believe that these antibodies should be checked for any case of atypical optic neuritis, which includes severe visual impairment, bilateral or recurrent optic neuritis, poor visual recovery, prominent disc edema, perineural optic nerve enhancement, or co-existing extra-optic nerve CNS demyelinating lesions suggestive of MOG-IgG or AQP4-IgG disease. It is important to differentiate MOG-IgG and AQP4-IgG disease from MS because the outcomes are different, and more importantly the treatment is different.

• #37 Optic neuritis | Eye

  https://www.nature.com/articles/eye201181

  The diagnosis of ON is a clinical one. Patients with typical ON, according to the ONTT, do require neither laboratory studies nor a lumbar puncture (LP) for diagnostic purposes. […] Magnetic resonance imaging (MRI) of the brain with and without gadolinium is typically recommended for prognostic purposes for MS but at present does not influence treatment in the United Kingdom, but may when disease modifying treatments are commenced in patients with clinically isolated syndromes such as ON. […] In the ONTT an abnormal baseline brain MRI was a strong predictor of MS after isolated ON in adults. […] Contrast enhancement of the optic nerve is a sensitive finding in acute ON, reported in up to 94% of cases. […] The diagnosis of NMO requires both clinical and radiographic findings. In addition to a LP and brain MRI, MRI imaging of the spine is essential in the workup for NMO. […] The diagnosis of NMO requires two absolute criteria and two of the three supportive criteria.

• #38 Diagnosis of Optic neuritis

  https://www.clinicbarcelona.org/en/assistance/diseases/optic-neuritis/diagnosis

  Optic neuritis is usually clinically diagnosed. This means that it is diagnosed by examining the patient. […] Visual acuity, colour perception, the visual field, and eye and pupil movements are checked. […] An imaging test, usually an MRI of the brain and optic nerves. […] It is also accompanied by an initial blood test to rule out infectious and autoimmune causes. […] In some cases, other complementary tests are necessary to determine the cause, such as a spinal cord MRI or a lumbar puncture.

• #39 Pulsenotes | Optic neuritis

  https://app.pulsenotes.com/specialities/ophthalmology/notes/optic-neuritis

  An MRI of the brain with or without the spine is important to look for any evidence of demyelinating lesions within the central nervous system. […] The swinging light test is completed to assess for a RAPD. […] Typical features of optic neuritis on LP include: Elevated protein, Elevated lymphocytes, Oligoclonal bands (OCB). […] The principal treatment of optic neuritis is high-dose, intravenous corticosteroids with methylprednisolone. […] The two major concerns following presentation with optic neuritis is visual recovery and risk of progression to multiple sclerosis.

• #40

  https://journals.lww.com/annalsofian/fulltext/2022/25002/a_practical_approach_to_the_diagnosis_and.2.aspx

  In the current era of biomarkers, anti-aquaporin 4 (AQP4) IgG and myelin oligodendrocyte glycoprotein (MOG) IgG autoantibodies as determined with cell base assay techniques are pivotal to diagnosing NMOSD and MOGAD, respectively. […] ON patients should be evaluated with orbital and cranial MRI scans to assist with diagnosis, treatment, and long-term management. […] The sensitivity of MRI for acute ON is approximately 80-94% when imaging occurs within 30 days of symptom onset. […] Concurrent brain MRI may demonstrate lesions diagnostic (or strongly suspicious) for MS, or suggest alternative inflammatory disorders. […] Oligoclonal banding is more commonly seen with MS ON than ON associated with NMOSD or MOGAD. […] For atypical ON cases, particularly when NMOSD is suspected, treatment is essential to prevent further vision loss and attempt to salvage function.

• #41 Diagnostic Approach to Atypical Optic Neuritis – EyeWiki

  https://eyewiki.org/Diagnostic_Approach_to_Atypical_Optic_Neuritis

  Optic neuropathy is a non-specific term characterized by dysfunction of the optic nerve. The acute inflammatory or demyelinating form of optic neuropathy that involves one or both optic nerves is termed optic neuritis (ON). The most common type of ON is labeled typical, or demyelinating ON, which may be associated with multiple sclerosis (MS) or may be idiopathic. Patients with typical ON generally have a favorable prognosis with good visual recovery regardless of treatment. In contrast, lack of visual recovery is a marker of atypical ON. This atypical ON can be caused by a heterogeneous collection of disorders including neuromyelitis optica (NMO), autoimmune optic neuropathy, chronic relapsing inflammatory optic neuropathy, myelin oligodendrocyte glycoprotein (MOG), idiopathic recurrent neuroretinitis, and optic neuropathy from systemic disease. If left untreated, atypical ON can lead to devastating visual results; therefore, it is crucial to recognize, initiate proper treatment, and preserve vision for patients with atypical ON.

• #42 The Diagnosis and Treatment of Optic Neuritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4581115/

  Typical optic neuritis is often the presenting manifestation of multiple sclerosis (MS). The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. In unilateral optic neuritis, the direct pupillary light reflex is weaker in the affected eye. The visual disturbance resolves in 95% of cases. High-dosed intravenous methylprednisolone therapy speeds recovery but does not improve the final outcome. The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. Optic neuritis is easy to distinguish from other diseases affecting the optic nerve. The clinical constellation of pain on eye movement, a relative afferent pupillary defect, and a normal or mildly edematous optic disc is pathognomonic for optic neuritis and suffices to establish the diagnosis. Unclear time of onset, lack of pain on eye movement, and lack of improvement of the visual deficit over time largely rule out optic neuritis. The task of the ophthalmologist is to provide objective evidence for the diagnosis. The optic disc usually appears normal but is mildly edematous in one-third of cases. The clinical history is important for the diagnosis of optic neuritis. The incidence of optic neuritis in central Europe is 5 cases per 100 000 persons per year. The mean age at onset is 36 years; it is rare in persons under 18 or over 50. The affected eye is blind in 3% of cases but has an acuity of 1.0 or better in 11% of cases. The diagnosis of multiple sclerosis requires the demonstration of inflammatory lesions in the central nervous system that are disseminated in both space and time. The Optic Neuritis Treatment Trial yielded precise figures on the risk of developing multiple sclerosis. Half of all patients with typical optic neuritis will develop multiple sclerosis within 15 years.

• #43 Diagnosis and Management of Optic Neuritis

  https://www.reviewofophthalmology.com/article/diagnosis-and-management-of-optic-neuritis

  The ON associated with idiopathic and multiple sclerosis usually involves: subacute vision loss; just one eye; pain that often worsens with eye movement; a relative afferent pupillary defect in cases of unilateral or asymmetric optic nerve involvement; and dyschromatopsia from the affected eye. […] Optic neuritis can manifest in autoimmune conditions of the central nervous system, infections and systemic diseases, such as: Multiple sclerosis; MOGAD; NMOSD; CRION, or chronic relapsing inflammatory optic neuritis; GFAP, or glial fibrillary acidic protein antibody-associated astrocytopathy; Tuberculosis, syphilis and cat-scratch fever; Sarcoidosis, Sjgrens syndrome, granulomatosis with polyangiitis. […] Unfortunately, the ER may lack diagnostic tools, such as OCT, to identify optic neuritis or exclude other causes of vision loss.

• #44 Optic neuritis: When it is and when it isn’t – EyeWorld

  https://www.eyeworld.org/2018/optic-neuritis-when-it-is-and-when-it-isnt/

  You need to be diligent about checking the pupils before dilation and making sure to check the color plates; these are ancillary tests that can lead you to the right diagnosis, even when an MRI is unavailable, Dr. Habash said. […] Over diagnosing this condition can be just as harmful as under diagnosis, Dr. Van Stavern said. […] According the Stunkel et al. study, the most common alternative diagnoses in patients who did not have optic neuritis were headache, functional vision loss, and optic neuropathies, such as nonarteritic anterior ischemic optic neuropathy, traumatic optic neuropathy, and others of unclear etiology. […] The lack of optic nerve dysfunction, and particularly the lack of a relative afferent pupillary defect, would argue strongly against optic neuritis, Dr. Van Stavern said.

• #45 Optic neuritis: When it is and when it isn’t – EyeWorld

  https://www.eyeworld.org/2018/optic-neuritis-when-it-is-and-when-it-isnt/

  You need to be diligent about checking the pupils before dilation and making sure to check the color plates; these are ancillary tests that can lead you to the right diagnosis, even when an MRI is unavailable, Dr. Habash said. […] Over diagnosing this condition can be just as harmful as under diagnosis, Dr. Van Stavern said. […] According the Stunkel et al. study, the most common alternative diagnoses in patients who did not have optic neuritis were headache, functional vision loss, and optic neuropathies, such as nonarteritic anterior ischemic optic neuropathy, traumatic optic neuropathy, and others of unclear etiology. […] The lack of optic nerve dysfunction, and particularly the lack of a relative afferent pupillary defect, would argue strongly against optic neuritis, Dr. Van Stavern said.

• #46 Optic Neuritis: Update on Diagnosis, Management, and Long-term Follow-up

  https://practicalneurology.com/articles/2009-oct/PN1009_02-php

  Optic neuritis (ON) may be considered part of a spectrum of significant optic nerve diseases, observes Thomas P. Leist, MD, PhD, Director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University. It is important to rule out transverse myelitis or a brain stem syndrome. In patients who are over age 45, it is also important to rule out other types of optic neuropathy, such as nonarteritic anterior ischemic optic neuropathy. As such, brain MRI, imaging of the optic nerve and anterior of the eye, and cervical spine are essential for patients with symptoms of ON. […] The use of corticosteroids to manage ON is standard, but, according to Peter A. Calabresi, MD, Professor of Neurology and Director, The Johns Hopkins Multiple Sclerosis Center at The Johns Hopkins University in Baltimore, We realistically have to tell patients that there are no good data to show that you’ll be in a better place a year later if you receive corticosteroid therapy.

• #47 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  Optic neuritis (ON) is an inflammatory condition of the optic nerve that is commonly seen in central nervous system demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-related diseases. […] The diagnosis of optic neuritis (inflammation of the optic nerve) is usually made clinically, with direct imaging of the optic nerves by magnetic resonance imaging (MRI) being reserved for atypical cases. […] MRI of the brain provides information that can change the management of optic neuritis and yields prognostic information regarding the patient’s future risk for the development of multiple sclerosis. […] As established by the Optic Neuritis Treatment Trial, an abnormal baseline brain MRI scan is a strong predictor of MS after isolated optic neuritis in adults.

• #48 The Diagnosis and Treatment of Optic Neuritis (11.09.2015)

  https://di.aerzteblatt.de/int/archive/article/171815

  The diagnosis of optic neuritis is based on a constellation of symptoms and signs. The onset is usually with pain on eye movement in one eye and subacute visual loss. […] The clinical constellation of pain on eye movement, a relative afferent pupillary defect, and a normal or mildly edematous optic disc is pathognomonic for optic neuritis and suffices to establish the diagnosis. […] The risk that a patient with optic neuritis will later develop multiple sclerosis can be assessed with an MRI scan of the brain. […] The diagnosis of multiple sclerosis requires the demonstration of inflammatory lesions in the central nervous system that are disseminated in both space and time. […] According to the revised McDonald criteria (2011), multiple sclerosis can be diagnosed when the MRI in a patient with optic neuritis reveals two or more typical lesions of multiple sclerosis, at least one of which is contrast-enhancing.

• #49 Optic neuritis: When it is and when it isn’t – EyeWorld

  https://www.eyeworld.org/2018/optic-neuritis-when-it-is-and-when-it-isnt/

  For about 20% of multiple sclerosis patients, optic neuritis is their first manifestation of the disease, so it is important to diagnose it accurately to identify patients who are at risk for multiple sclerosis, and to avoid misclassifying patients who are not likely to develop multiple sclerosis, Dr. Van Stavern said. […] If there is a high suspicion of optic neuritis, Dr. Habash said, an MRI is warranted, as it can help determine if the optic nerve is enhancing or if there are white matter lesions. […] Dr. Van Stavern said that every patient with demyelinating optic neuritis should have a brain MRI with and without gadolinium. This not only helps confirm optic neuritis but can stratify patients in terms of multiple sclerosis diagnosis or risk. […] The newest criteria for multiple sclerosis allow the diagnosis even after a single attack of optic neuritis, depending upon the MRI, Dr. Van Stavern said.

• #50 Optic neuritis and risk of MS: Differential diagnosis and management | MDedge

  https://ma1.mdedge.com/content/optic-neuritis-and-risk-ms-differential-diagnosis-and-management

  Brain MRI may show other white matter lesions (either hyperintensities on T2-weighted images or enhancement of T1-weighted images postcontrast), which denote a higher risk of developing MS. […] In 15-year follow-up data from the ONTT, monosymptomatic patients with no white matter lesions had a 25% risk of MS (defined at the time the ONTT was conducted as a second demyelinating event), while those with one lesion or more had a 72% risk. […] Patients with optic neuritis who have no white matter lesions on brain MRI may be further risk-stratified on the basis of their clinical findings. […] The most important clinical decision to make in patients with optic neuritis is whether to begin immunomodulatory therapy. […] Therefore, once the diagnosis is secure, patients with optic neuritis should be referred to a neurologist with experience in treating MS to begin treatment with immunomodulatory therapy, such as glatiramer acetate (Copaxone), interferon beta-1a (Avonex, Refib), or interferon beta-1b (Betaseron).

• #51 Typical and atypical optic neuritis – diagnosis and initial management | Eye News

  https://www.eyenews.uk.com/education/top-tips/post/typical-and-atypical-optic-neuritis-diagnosis-and-initial-management

  For typical optic neuritis, it is very important to discuss the natural history of their condition including the high probability that vision will usually recover well and to discuss the risks and benefits of steroid treatment. (Faster recovery to normal if vision worse than 6/12 but no long-term difference in visual prognosis compared with those not treated with intravenous steroids). Patients should also be counselled that there is a risk of developing MS in the future. Although it is not possible to predict this, demyelinating lesions on MRI brain increases the risk of developing MS to 72% and absence of lesions, reduces this risk to 25%.

• #52 Optic neuritis: When it is and when it isn’t – EyeWorld

  https://www.eyeworld.org/2018/optic-neuritis-when-it-is-and-when-it-isnt/

  Based on the Optic Neuritis Treatment Trial, Dr. Van Stavern usually recommends observation or treatment with high-dose IV methylprednisolone, which was shown to speed recovery, though it showed no difference in visual outcomes. […] If there is severe vision loss upon presentation with optic neuritis, Dr. Van Stavern said it can raise concerns about another demyelinating disorder, such as neuromyelitis optica. This can be diagnosed with a blood test. […] As for the risk of recurrence of optic neuritis, Dr. Van Stavern said if the MRI shows at least one lesion associated with multiple sclerosis, the risk is 75% over 15 years; if the MRI looks normal, the risk of developing multiple sclerosis and/or having another optic neuritis episode is about 20% within 15 years.

• #53

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  Over the past few years, there has been remarkable development in the area of optic neuritis. The discovery of new antibodies has improved our understanding of the pathology of the disease. Antiaquaporin4 antibodies and antimyelin oligodendrocytes antibodies are now considered as distinct entities of optic neuritis with their specific clinical presentation, neuroimaging characteristics, treatment options, and course of the disease. […] The landscape of optic neuritis (ON) is rapidly changing with the discovery of new antibodies, advent of latest investigations, and revised diagnostic criteria. In view of these developments, it is vital to revise our approach to the management of ON. […] Detailed history taking and thorough clinical workup are essential to differentiate ON from other causes of optic neuropathy. Neuroimaging and laboratory workup is a mandatory part of workup to diagnose various etiological causes.

• #54

  https://journals.lww.com/annalsofian/fulltext/2022/25002/a_practical_approach_to_the_diagnosis_and.2.aspx

  Optic neuritis (ON), as an umbrella term, refers to a spectrum of inflammatory optic neuropathies arising from a myriad of potential causes. […] The Optic Neuritis Treatment Trial (ONTT) has historically guided our treatment of ON, and taught us important lessons about the clinical presentation, visual prognosis, and future risk of multiple sclerosis (MS) diagnosis associated with this condition. […] It is imperative that clinicians be aware of the diagnostic approach and management options for these conditions. […] In this review, we will discuss the diagnostic approach to ON, review common ON subtypes that are encountered in clinical practice, and highlight how acute and long-term treatment strategies differ between ON variants. […] The diagnosis of ON can be challenging. […] Clinical features considered atypical for ON should prompt consideration for an alternative diagnosis.

• #55 Optic Neuritis, its Differential Diagnosis and Management

  https://openophthalmologyjournal.com/VOLUME/6/PAGE/65/FULLTEXT/

  The aim of this review is to summarize the latest information about optic neuritis, its differential diagnosis and management. […] The clinical diagnosis of ON consists of the classic triad of visual loss, periocular pain and dyschromatopsia which requires careful ophthalmic, neurologic and systemic examinations to distinguish between typical and atypical ON. […] Therefore, differential diagnosis is necessary to make a proper treatment plan. […] The gold standard treatment for ON is based on the Optic Neuritis Treatment Trial (ONTT) which was undertaken in order to determine the efficacy of corticosteroids and to permit long-term analyses. […] According to the ONTT, patient with typical ON does not require laboratory studies and lumbar puncture (LP) while in atypical ON careful examination is required to establish the correct treatment regimen specifically in children, bilateral cases or when systemic or infectious diseases are in doubt.

• #56 Optic Neuritis: Causes, Symptoms, Risk Factors, and Treatment

  https://www.healthline.com/health/optic-neuritis

  Optic neuritis (ON) is an inflammation that damages your optic nerve. […] Early diagnosis and treatment can improve your outcome. […] Whenever you notice changes to your vision, its important to get it checked by a doctor or an ophthalmologist. […] A doctor will typically begin their diagnosis by asking you about your symptoms and medical history. Theyll then perform a physical exam. To ensure the best treatment, your doctor may perform additional tests to determine the cause of your ON. […] Tests for ON can include blood tests or a cerebrospinal fluid analysis. […] The doctor may also request imaging tests, such as: an optical coherence tomography scan, which looks at the nerves in the back of your eye; an MRI scan, which uses a magnetic field and radio waves to create a detailed image of your brain or other parts of your body; a CT scan, which creates a cross-sectional X-ray image. […] A doctor can assess your symptoms and use tests to help determine whether you have ON or another condition.

• #57 Optic Neuritis: Update on Diagnosis, Management, and Long-term Follow-up

  https://practicalneurology.com/series/practice-management/PN1009_02-php/30879/

  According to Dr. Leist, If the patient has optic neuritis and MRI that shows two or more lesions in locations appropriate for MS, then this patient becomes a candidate for treatment with MS therapies. […] Given the association of ON with progression to MS in certain patients, efforts are underway to improve the long-term monitoring of patients at high risk for developing MS and to identify treatments that will yield the greatest benefit for all patients with ON. […] Other more widespread diagnostic tools are used currently to track ocular changes following ON or in suspected or definite MS. […] Low-contrast visual acuity has been used as a measure of disease progression in MS trials and has been correlated with measures of MS patients’ quality of life. […] Visual evoked potentials (VEPs) are commonly used to identify or monitor changes in retinal nerve function.

• #58 Demyelinating Optic Neuritis – EyeWiki

  https://eyewiki.org/Demyelinating_Optic_Neuritis

  An MRI depicting enhancement of the optic nerve after administration of gadolinium is helpful but not required to make the clinical diagnosis. […] Optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer (pRNFL) is helpful as an adjunctive measurement of nerve function in patients with ON. […] A lumbar puncture is not required for the diagnosis of ON. […] Bilateral ON with poor visual recovery is atypical and further testing with blood tests for NMOSD, MOG and other infectious and inflammatory diseases and neuroimaging of the brain and spine may be considered. […] The ONTT was a landmark multi-center, randomized, prospective, controlled clinical trial designed to evaluate the efficacy and safety of oral prednisone vs. intravenous methylprednisolone followed by oral prednisone as compared with oral placebo for the treatment of acute ON.

• #59

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  The treatment of ON can be divided into the management of the acute episode, long-term management for the prevention of relapse, and strategies for neuro-regeneration. An approach to acute and long-term management of ON is provided. […] High-dose intravenous steroids are the treatment of choice for acute ON. The most definitive evidence comes from the ONTT which compared three treatment modalities: intravenous steroids vs oral steroids vs placebo. […] The treatment effect of intravenous steroids is limited for patients with NMOSD and repeated steroid treatment in these patients has not been shown to improve the rate of disease remission. […] The treatment of MS includes disease-modifying drugs (DMD) such as interferon, immunomodulators like glatiramer acetate (GA) and fingolimod, and monoclonal antibodies like natalizumab.

• #60 Neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disorder-optic neuritis: a comprehensive review of diagnosis and treatment | Eye

  https://www.nature.com/articles/s41433-020-01334-8

  Gadolinium-enhanced MRI reveals optic nerve enhancement in ~94% of cases of acute ON. […] Importantly, however, extensive optic nerve involvement does not distinguish NMOSD-ON from MOGAD-ON. […] For those patients with MRI optic nerve abnormalities suspicious for NMOSD-ON, spine imaging should be performed to assess for longitudinally extensive transverse myelitis. […] The clinical suspicion for NMOSD-ON may be informed by in-office ancillary testing. […] Optical coherence tomography (OCT) is of minimal value in distinguishing NMOSD-ON from idiopathic-ON/MS-ON in the acute phase. […] The hallmark of NMOSD is a relapsing course with relentless, stepwise progression of neurological disability, including blindness. […] Treatment of acute flares of NMOSD-ON is imperative to reduce long-term visual morbidity. IVMP is the mainstay of treatment, and early treatment has been shown to correlate with preservation of pRNFL. […] The necessity of long-term immunosuppressive therapy for MOGAD is less clear-cut than in AQP4-IgG seropositive NMOSD.

• #61

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  Neuromyelitis optic spectrum disorder (NMOSD) is a debilitating disease with severe relapses and permanent disability. Therefore, it is important to plan long-term immunosuppression to maintain remission and prevent relapses. […] Myelin oligodendrocyte associated ON (MOG-ON) has a good visual prognosis but has more frequent relapses as compared to MS and NMO. The maintenance therapy includes oral steroids slowly tapered over few weeks followed by azathioprine. […] We conclude that typical ON or MS-ON can be diagnosed with the help of neuroimaging and CSF studies. An atypical ON should be thoroughly investigated since timely diagnosis and prompt treatment is key to prevent relapses and improve the prognosis.

• #62 Optic Neuritis in the Era of Biomarkers – Insights

  https://news.mayocliniclabs.com/2019/06/03/optic-neuritis-in-the-era-of-biomarkers/

  It is an exciting time to be a neuro-ophthalmologist because of the availability of these new biomarkers for optic neuritis. We are able to better diagnose diseases that were previously thought to be idiopathic, which allows us to better prognosticate outcomes and provide better treatments. An understanding of the pathogenesis of these disease processes ultimately leads to directed therapies. […] Based on this Hot Topic, I hope you were able to appreciate the importance of checking for AQP4 and MOG antibodies in cases of atypical optic neuritis because their presence will alter the expected prognosis and optimal treatment.

• #63

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  Over the past few years, there has been remarkable development in the area of optic neuritis. The discovery of new antibodies has improved our understanding of the pathology of the disease. Antiaquaporin4 antibodies and antimyelin oligodendrocytes antibodies are now considered as distinct entities of optic neuritis with their specific clinical presentation, neuroimaging characteristics, treatment options, and course of the disease. […] The landscape of optic neuritis (ON) is rapidly changing with the discovery of new antibodies, advent of latest investigations, and revised diagnostic criteria. In view of these developments, it is vital to revise our approach to the management of ON. […] Detailed history taking and thorough clinical workup are essential to differentiate ON from other causes of optic neuropathy. Neuroimaging and laboratory workup is a mandatory part of workup to diagnose various etiological causes.

• #64 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  In atypical cases (eg, prolonged or severe pain, lack of visual recovery, atypical visual-field loss, evidence of orbital inflammation and/or inflammation), MRI is used to further characterize and to exclude other disease processes. […] The signal intensity ratio (SIR) of the optic nerve to the white matter (WM) on STIR was found to be of diagnostic value for acute optic neuritis (AON) in a study of 405 patients with suspected orbital diseases who underwent orbital MRI with a 3-T scanner. […] Optic neuritis in neuromyelitis optica was found to have a distinct pattern on MRI, as compared to relapsing-remitting multiple sclerosis. […] In a study of 31 patients with optic neuritis, 3-dimensional double inversion recovery (3D DIR) was found to provide improved detection of optic nerve signal abnormalities over 2-dimensional (2D) short tau inversion recovery (STIR) fluid-attenuated inversion recovery (FLAIR).

• #65 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  In a study of 42 patients with suspected optic neuritis, perioptic leptomeningeal contrast enhancement on fat-suppressed FLAIR images was identified as a novel marker in optic neuritis, possibly reflecting a leptomeningeal inflammatory process preceding or accompanying optic neuritis. […] The real contribution of imaging in the setting of optic neuritis is made by imaging of the brain, not of the optic nerves themselves. […] Between 27% and 70% of patients (in various studies) with isolated optic neuritis show abnormal MRI brain findings, as defined by the presence of 2 or more white matter lesions on T2-weighted images. […] The Optic Neuritis Treatment Trial found that there was a 50% cumulative probability of developing MS within 15 years after the onset of optic neuritis. […] The presence of lesions on a baseline, noncontrast-enhanced MRI of the brain was a significant factor in the occurrence of MS. […] Information from brain MRI has a potential influence on treatment.

• #66 From diagnosis to treatment: exploring the mechanisms underlying optic neuritis in multiple sclerosis | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-025-06105-1

  OCT enables the assessment of potential reductions in RNFL thickness and ganglion cell layer (GCL) thickness linked to pathological impacts upon the optic nerve. […] A meta-analysis including 40 studies found that OCT reliably detects retinal thinning in MS patients, with reductions of 9-18% observed in the RNFL and 7-15% in the GCL compared to healthy controls. […] The diagnosis of MS relies on neurological symptoms and signs, alongside evidence of CNS lesion dissemination in space and time. […] Approximately 60-80% of patients with acute optic neuritis exhibit non-specific CSF abnormalities, including elevated lymphocyte counts and protein levels. […] The progress in the creation of disease-modifying therapies for MS has been remarkable in the past thirty years. […] First-line therapies for ON in MS include corticosteroids, interferons, and anti-CD20 monoclonal antibodies.

• #67 Optic Neuritis in the Era of Biomarkers – Insights

  https://news.mayocliniclabs.com/2019/06/03/optic-neuritis-in-the-era-of-biomarkers/

  Antibodies to aquaporin-4 and myelin oligodendrocyte glycoprotein (MOG) are recently described biomarkers seen in a subset of atypical optic neuritis which have revolutionized our understanding of optic neuritis. […] The ONTT did a wonderful job of providing guidance for cases of typical optic neuritis. However, there were cases of atypical optic neuritis that were unexplained until more recently. We now have biomarkers of optic neuritis, which are offered by the Mayo Clinic Neuroimmunology Laboratory, that help explain many cases of atypical optic neuritis, such as severe optic neuritis with poor recovery, bilateral optic neuritis, prominent disc edema, and relapsing optic neuritis. […] One question we are often asked is, when should we test for AQP4 and MOG antibodies? We believe that these antibodies should be checked for any case of atypical optic neuritis, which includes severe visual impairment, bilateral or recurrent optic neuritis, poor visual recovery, prominent disc edema, perineural optic nerve enhancement, or co-existing extra-optic nerve CNS demyelinating lesions suggestive of MOG-IgG or AQP4-IgG disease. It is important to differentiate MOG-IgG and AQP4-IgG disease from MS because the outcomes are different, and more importantly the treatment is different.

• #68 From diagnosis to treatment: exploring the mechanisms underlying optic neuritis in multiple sclerosis | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-025-06105-1

  The established markers of visual impairment in patients with MS, including visual field, visual acuity, retinal nerve fiber layer (RNFL) thickness, macular volume or thickness, VEP, as well as immune cells and glial cells, can all be identified using the aforementioned techniques. […] In conclusion, LCLA provides a sensitive test for diagnosing and tracking visual impairment in MS patients. […] Optic nerve MRI aids in diagnosing visual impairment in MS by providing information about optic nerve pathology and changes in tissue histology that may not be discernible through routine visual examination. […] The latest research shows that incorporating symptomatic optic nerve involvement into Disability status scale criteria can improve the overall efficacy of MS diagnostic, specifically increasing the sensitivity of MS diagnosis from 83 to 95% and the overall accuracy from 78 to 81%.

• #69 From diagnosis to treatment: exploring the mechanisms underlying optic neuritis in multiple sclerosis | Journal of Translational Medicine | Full Text

  https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-025-06105-1

  Therapies targeted against T cells and B cells have been shown to alleviate ON caused by MS. […] Increasing evidence indicates that MS can cause ON. Ocular diagnostic techniques, in particular MRI, OCT, and OCTA, are crucial for the diagnosis and early detection of MS. […] These methods allow for the evaluation of vascular density, ganglion cell complex, and RNFL thickness—all of which have been proposed as potential predictive indicators for MS.

• #70 Diagnosis and Management of Optic Neuritis

  https://www.reviewofophthalmology.com/article/diagnosis-and-management-of-optic-neuritis

  So, yes, misdiagnosed cases of optic neuritis exist. […] At last count: fewer than 700, nationwidewhich increases the urgency to get the diagnosis right on the patients initial visit. […] The discovery of NMOSD and MOGAD led researchers to think they could learn more about differentiating MS, but that didnt happen. […] Diagnosis isnt always apparent, even using those specialized tools in eye clinics, says Dr. Costello. […] Advances in artificial intelligence could aid with more rapid, accurate diagnoses. […] Our job is to make as rapid a diagnosis as we can, to treat as quickly as possible.

• #71 Optic neuritis: When it is and when it isn’t – EyeWorld

  https://www.eyeworld.org/2018/optic-neuritis-when-it-is-and-when-it-isnt/

  Most comprehensive ophthalmologists have the skills and tools to effectively diagnose optic neuritis, said Gregory Van Stavern, MD, professor, Department of Ophthalmology, and director, Visual Electrophysiology Services, Washington University School of Medicine, St. Louis. […] Yet, Dr. Van Stavern and co-investigators reviewed data of acute optic neuritis referrals and found nearly 60% from that set actually had an alternative diagnosis. […] Understanding the pitfalls leading to over diagnosis of optic neuritis may improve clinicians diagnostic process, Stunkel et al. concluded in the study. […] Optic neuritis is inflammation of the optic nerve. A wide variety of autoimmune and infectious diseases can cause optic neuritis, but the vast majority are cases of demyelinating optic neuritis, Dr. Van Stavern said, attributing much of whats known about this condition to the Optic Neuritis Treatment Trial.

• #72 Optic neuritis: When it is and when it isn’t – EyeWorld

  https://www.eyeworld.org/2018/optic-neuritis-when-it-is-and-when-it-isnt/

  For about 20% of multiple sclerosis patients, optic neuritis is their first manifestation of the disease, so it is important to diagnose it accurately to identify patients who are at risk for multiple sclerosis, and to avoid misclassifying patients who are not likely to develop multiple sclerosis, Dr. Van Stavern said. […] If there is a high suspicion of optic neuritis, Dr. Habash said, an MRI is warranted, as it can help determine if the optic nerve is enhancing or if there are white matter lesions. […] Dr. Van Stavern said that every patient with demyelinating optic neuritis should have a brain MRI with and without gadolinium. This not only helps confirm optic neuritis but can stratify patients in terms of multiple sclerosis diagnosis or risk. […] The newest criteria for multiple sclerosis allow the diagnosis even after a single attack of optic neuritis, depending upon the MRI, Dr. Van Stavern said.

• #73 Optic neuritis: When it is and when it isn’t – EyeWorld

  https://www.eyeworld.org/2018/optic-neuritis-when-it-is-and-when-it-isnt/

  You need to be diligent about checking the pupils before dilation and making sure to check the color plates; these are ancillary tests that can lead you to the right diagnosis, even when an MRI is unavailable, Dr. Habash said. […] Over diagnosing this condition can be just as harmful as under diagnosis, Dr. Van Stavern said. […] According the Stunkel et al. study, the most common alternative diagnoses in patients who did not have optic neuritis were headache, functional vision loss, and optic neuropathies, such as nonarteritic anterior ischemic optic neuropathy, traumatic optic neuropathy, and others of unclear etiology. […] The lack of optic nerve dysfunction, and particularly the lack of a relative afferent pupillary defect, would argue strongly against optic neuritis, Dr. Van Stavern said.

• #74 Optic Neuritis: Update on Diagnosis, Management, and Long-term Follow-up

  https://practicalneurology.com/articles/2009-oct/PN1009_02-php

  Optic neuritis (ON) may be considered part of a spectrum of significant optic nerve diseases, observes Thomas P. Leist, MD, PhD, Director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University. It is important to rule out transverse myelitis or a brain stem syndrome. In patients who are over age 45, it is also important to rule out other types of optic neuropathy, such as nonarteritic anterior ischemic optic neuropathy. As such, brain MRI, imaging of the optic nerve and anterior of the eye, and cervical spine are essential for patients with symptoms of ON. […] The use of corticosteroids to manage ON is standard, but, according to Peter A. Calabresi, MD, Professor of Neurology and Director, The Johns Hopkins Multiple Sclerosis Center at The Johns Hopkins University in Baltimore, We realistically have to tell patients that there are no good data to show that you’ll be in a better place a year later if you receive corticosteroid therapy.

• #75 Optic Neuritis: Symptoms, Causes & Treatment Options

  https://my.clevelandclinic.org/health/diseases/14256-optic-neuritis

  Optic neuritis is when inflammation in your optic nerve causes pain, vision loss and other symptoms. Timely diagnosis and treatment may help optic neuritis and limit or delay more severe long-term effects or conditions. […] An eye care specialist may suspect optic neuritis based on: Your symptoms. Your medical history. If you have (or could have) another condition that could cause optic neuritis. […] The following tests are also likely early on: Visual evoked potentials. Optical coherence tomography. […] If the above checks and test results are consistent with optic neuritis, and another condition doesn’t better explain your symptoms, your eye care provider will probably refer you to a specialist. This may be a neurologist or a neuro-ophthalmologist (an eye care specialist who focuses on retinal and optic nerve issues and conditions).

• #76 Optic Neuritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557853/

  Optic neuritis is a vision-threatening disorder and often the first symptom of demyelinating diseases such as multiple sclerosis. […] Diagnosis involves a thorough clinical evaluation and the use of advanced imaging modalities, particularly optical coherence tomography and magnetic resonance imaging. […] Diagnosis of optic neuritis involves both clinical evaluation and imaging studies. Magnetic resonance imaging (MRI) of the brain and orbits with gadolinium contrast is the imaging modality of choice. MRI can help visualize optic nerve inflammation and detect any demyelinating plaques in the brain, which may indicate a high risk for multiple sclerosis. […] The mainstay of treatment for optic neuritis is high-dose corticosteroids, typically administered intravenously for a short course, followed by an oral taper.

• #77 Optic Neuritis Imaging: Practice Essentials, Magnetic Resonance Imaging

  https://emedicine.medscape.com/article/383642-overview

  Optic neuritis (ON) is an inflammatory condition of the optic nerve that is commonly seen in central nervous system demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-related diseases. […] The diagnosis of optic neuritis (inflammation of the optic nerve) is usually made clinically, with direct imaging of the optic nerves by magnetic resonance imaging (MRI) being reserved for atypical cases. […] MRI of the brain provides information that can change the management of optic neuritis and yields prognostic information regarding the patient’s future risk for the development of multiple sclerosis. […] As established by the Optic Neuritis Treatment Trial, an abnormal baseline brain MRI scan is a strong predictor of MS after isolated optic neuritis in adults.

• #78

  https://journals.lww.com/annalsofian/fulltext/2022/25002/a_practical_approach_to_the_diagnosis_and.2.aspx

  The short- and long-term prognoses for visual recovery vary with ON subtype, and to a lesser extent, patient genetics, gender, and environmental factors. […] It is imperative that clinicians are comfortable with these emerging ON subtypes entities so they can recognize the clinical associations they herald and manage these cases appropriately.

• #79

  https://journals.lww.com/ijo/fulltext/2021/09000/approach_to_optic_neuritis__an_update.7.aspx

  The treatment of ON can be divided into the management of the acute episode, long-term management for the prevention of relapse, and strategies for neuro-regeneration. An approach to acute and long-term management of ON is provided. […] High-dose intravenous steroids are the treatment of choice for acute ON. The most definitive evidence comes from the ONTT which compared three treatment modalities: intravenous steroids vs oral steroids vs placebo. […] The treatment effect of intravenous steroids is limited for patients with NMOSD and repeated steroid treatment in these patients has not been shown to improve the rate of disease remission. […] The treatment of MS includes disease-modifying drugs (DMD) such as interferon, immunomodulators like glatiramer acetate (GA) and fingolimod, and monoclonal antibodies like natalizumab.

• #80 Neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disorder-optic neuritis: a comprehensive review of diagnosis and treatment | Eye

  https://www.nature.com/articles/s41433-020-01334-8

  Gadolinium-enhanced MRI reveals optic nerve enhancement in ~94% of cases of acute ON. […] Importantly, however, extensive optic nerve involvement does not distinguish NMOSD-ON from MOGAD-ON. […] For those patients with MRI optic nerve abnormalities suspicious for NMOSD-ON, spine imaging should be performed to assess for longitudinally extensive transverse myelitis. […] The clinical suspicion for NMOSD-ON may be informed by in-office ancillary testing. […] Optical coherence tomography (OCT) is of minimal value in distinguishing NMOSD-ON from idiopathic-ON/MS-ON in the acute phase. […] The hallmark of NMOSD is a relapsing course with relentless, stepwise progression of neurological disability, including blindness. […] Treatment of acute flares of NMOSD-ON is imperative to reduce long-term visual morbidity. IVMP is the mainstay of treatment, and early treatment has been shown to correlate with preservation of pRNFL. […] The necessity of long-term immunosuppressive therapy for MOGAD is less clear-cut than in AQP4-IgG seropositive NMOSD.

• #81 Optic neuritis and risk of MS: Differential diagnosis and management | MDedge

  https://ma1.mdedge.com/content/optic-neuritis-and-risk-ms-differential-diagnosis-and-management

  Brain MRI may show other white matter lesions (either hyperintensities on T2-weighted images or enhancement of T1-weighted images postcontrast), which denote a higher risk of developing MS. […] In 15-year follow-up data from the ONTT, monosymptomatic patients with no white matter lesions had a 25% risk of MS (defined at the time the ONTT was conducted as a second demyelinating event), while those with one lesion or more had a 72% risk. […] Patients with optic neuritis who have no white matter lesions on brain MRI may be further risk-stratified on the basis of their clinical findings. […] The most important clinical decision to make in patients with optic neuritis is whether to begin immunomodulatory therapy. […] Therefore, once the diagnosis is secure, patients with optic neuritis should be referred to a neurologist with experience in treating MS to begin treatment with immunomodulatory therapy, such as glatiramer acetate (Copaxone), interferon beta-1a (Avonex, Refib), or interferon beta-1b (Betaseron).

• #82 Optic Neuritis: Who Is At Risk for MS?

  https://www.reviewofophthalmology.com/article/optic-neuritis-who-is-at-risk-for-ms

  The presence of even one demyelinated plaque (i.e. a single 3-mm diameter white matter lesion visible on the brain MRI) placed the patient at a higher risk for MS than if lesions were absent on MRI. […] For prognostic purposes, an MRI should be done at the time of the first demyelinating event. […] The absence of certain clinical features typical of demyelinating ON, also lowered the risk of MS. […] The protocol for Solumedrol treatment has been variously modified without scientific verification of efficacy. […] The patient with typical, isolated, monosymptomatic ON should be referred promptly to a neurologist who can begin immunomodulatory medication. […] The neurologist relies on the ophthalmologist to accurately diagnose ON and to distinguish demyelinating ON from other optic neuropathies or retinal conditions that have similar symptoms.

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