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Optic neuropathy: A 15-year retrospective observational study.

José Miguel Alves1, Mafalda Seabra2, Luís Braz2

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Some optic neuropathies (ON) initially diagnosed may be redefined over time. Patients with atypical ON presentations are less likely to have their diagnosis changed during follow-up.

Keywords:
Delayed diagnosisOptic nerve diseasesRecurrenceVision disordersVisual acuity

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Area of Science:

  • Neurology
  • Ophthalmology

Background:

  • Optic neuropathies (ON) encompass diverse etiologies, with diagnoses sometimes evolving after further investigation or new neurological events.
  • Understanding diagnostic changes and predictive factors is crucial for managing ON patients.

Purpose of the Study:

  • To report clinical and paraclinical findings, treatments, and disease course in patients with suspected acute or subacute optic neuropathy.
  • To explore diagnosis redefinition during follow-up and identify potential predictive factors for diagnostic changes.

Main Methods:

  • Retrospective review of 156 patients with ON admitted between January 2004 and August 2019.
  • Analysis of clinical, laboratory, imaging data, treatment protocols, and follow-up information.

Main Results:

  • At discharge, diagnoses included idiopathic ON (53.2%), multiple sclerosis-related ON (24.4%), and ischemic ON (14.7%).
  • 17.3% of patients had their diagnosis redefined during follow-up, with a median time of 12.3 months.
  • Atypical ON presentations (e.g., bilateral involvement, severe visual acuity loss) were associated with a lower risk of diagnosis change (HR=0.320).

Conclusions:

  • A significant proportion of patients admitted with optic neuropathy experience diagnosis redefinition during follow-up.
  • Atypical optic neuritis presentations are more likely to maintain their initial diagnosis.
  • Findings align with and reinforce conclusions from previous international studies on optic neuropathies.