Differential diagnosis and clinical predictors in suspected optic neuritis

Rapid diagnosis and initiation of treatment are essential to improve outcomes for optic neuritis. However, many patients suspected of having optic neuritis may have different underlying conditions. This study aimed to investigate the spectrum of diseases in patients referred with suspected optic neuritis and to identify clinical factors associated with confirmed optic neuritis.

Retrospective cohort study METHODS: This study retrospectively reviewed 255 cases referred to Kobe University Hospital with suspected optic neuritis between January 2016 and June 2024. Cases were excluded if patients had a history of optic neuritis, encephalitis, or myelitis, were referred from non-ophthalmology departments, or resided outside Hyogo Prefecture. Logistic regression analysis was conducted to identify factors significantly associated with confirmed optic neuritis.

Of the 206 eligible cases, 89 (43.2%) were confirmed to have optic neuritis. Other major diagnoses included anterior ischemic optic neuropathy (18.4%), space-occupying lesions such as intracranial tumors (11.7%), and retinal diseases or uveitis (10.2%). Logistic regression analysis revealed significant associations between confirmed optic neuritis and younger age, the presence of central scotoma, eye pain, decreased visual acuity, reduced critical flicker fusion frequency, and a shorter interval between symptom onset and consultation.

Although 43.2% of suspected cases were confirmed as optic neuritis, a substantial proportion was attributed to other conditions requiring distinct diagnostic and therapeutic approaches. These findings emphasize the critical role of multidisciplinary collaboration and evidence-based protocols in managing patients with acute visual impairment.