Predicting the final clinical phenotype after the first attack of optic neuritis

Area of Science:

• Neuroimmunology
• Ophthalmology
• Neurology

Background:

• Optic neuritis (ON) can be an isolated event or signal a chronic neuroimmunological condition.
• Identifying early predictors of the final clinical phenotype is crucial for patient management.

Purpose of the Study:

• To evaluate factors that predict the final clinical phenotype after an initial isolated attack of optic neuritis (ON).

Main Methods:

• Retrospective analysis of 64 patients with initial isolated ON.
• Compared demographic, clinical, and imaging predictors across final phenotypes: multiple sclerosis (MS), idiopathic ON, neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disease (MOGAD), and secondary ON.

Main Results:

• Final phenotypes included MS (34%), idiopathic ON (22%), MOGAD (17%), NMOSD (16%), and secondary ON (11%).
• Predictors varied by phenotype: e.g., White race and brain MRI demyelination for MS; older age and PLEX requirement for NMOSD; African American race and optic MRI findings for MOGAD.

Conclusions:

• The final clinical phenotype of ON is likely predictable at initial presentation.
• Demographics, treatment response, fundoscopy, OCT, and MRI are key predictors.
• Early prediction can guide prognosis and management decisions for ON patients.