This study was driven by a lack of consensus regarding precise diagnostic criteria and classification of optic neuritis. Based on a 3-year Delphi process, consensus was established regarding terminology, pertinent clinical findings and classification amongst neurologists and ophthalmologists worldwide.1 Proposed diagnostic criteria combine clinical features (monocular or binocular subacute visual loss with or without orbital pain, reduced contrast and color vision, relative afferent pupillary deficit) and paraclinical tests such as optical coherence tomography (OCT, demonstrating optic disc swelling acutely or an inter-eye difference of specific OCT-parameters within 3 months), MRI (demonstrating contrast-enhancement of the symptomatic optic nerve and sheaths acutely or an intrinsic signal increase within 3 months) and biomarkers (CSF oligoclonal bands, AQP4, MOG, CRMP5 antibody seropositive). For a definite optic neuritis, depending on the clinical features identified, confirmation by one or several paraclinical tests is required. A three-level classification of optic neuritis was proposed, with level 1 aiming at a dichotomization (autoimmune [usually relapsing] vs. infectious / systemic [usually monophasic]) to guide general management and decisions on immunosuppressive treatment needed based on the likelihood of a future relapse and level 2 characterizing optic neuritis subtypes with sufficient clinical and paraclinical features to consider them distinct. Level 3 classification was based on expert opinion only. In conclusion, the proposed diagnostic criteria and classification of optic neuritis have the potential to reduce the risk of misdiagnosis and guide and accelerate targeted treatment. The lack of consensus regarding treatment options in optic neuritis emphasizes the need for further treatment trials.
Key Points:
- Newly elaborated consensus paper based on the Delphi process providing precise diagnostic criteria and a subtype classification of optic neuritis.
- Conditions other than multiple sclerosis are frequent causes of optic neuritis
- Proposed diagnostic criteria for definitive / possible optic neuritis are based on clinical features and paraclinical tests, including (brain, retinal, orbital) imaging and (CSF oligoclonal band/antibody) biomarker data.
- Proposed classification of optic neuritis distinguishes two main levels (autoimmune vs. infectious/systemic), which have a significant impact on prognosis and thus on the decision whether to start an immunosuppressive treatment.
- The lack of consensus regarding treatment options in optic neuritis emphasizes the need for further treatment trials.
References:
- Petzold A, et al. Diagnosis and classification of optic neuritis. Lancet Neurol. 2022 Dec;21(12):1120-1134. doi: 10.1016/S1474-4422(22)00200-9. Epub 2022 Sep 27. PMID: 36179757.
Co-author(s):
Caroline Froment Tilikete, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR 5292, IMPACT F-69500 Bron, France and 4) Neuro‑Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital, Lyon, France
Publish on behalf of the Scientific Panel on Neuro-ophthalmology and -otology