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Related Experiment Video

Updated: Jun 3, 2026

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
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Published on: April 14, 2014

Subclinical Optic Nerve Involvement in Radiologically Isolated Syndrome: Multimodal Detection and Diagnostic Impact.

Christine Lebrun-Frenay1,2, Cassandre Landes-Château1, Lydiane Mondot1

  • 1UR2CA URRIS, Université Nice Côte D'azur, Nice, France.

Annals of Clinical and Translational Neurology
|June 2, 2026
PubMed
Summary

Subclinical optic nerve (ON) lesions are common in radiologically isolated syndrome (RIS), detected by OCT and VEP, not MRI. These lesions do not predict clinical conversion but may lower diagnostic specificity.

Keywords:
diagnostic criteriamultiple sclerosisoptic nerve

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Area of Science:

  • Neuroimaging
  • Neurology
  • Ophthalmology

Background:

  • Radiologically isolated syndrome (RIS) is a condition characterized by MRI findings suggestive of demyelination without clinical symptoms.
  • Subclinical lesions, particularly in the optic nerve (ON), may play a role in disease progression.
  • Assessing ON lesions using MRI, optical coherence tomography (OCT), and visual evoked potentials (VEP) is crucial for understanding RIS.

Purpose of the Study:

  • To determine the frequency of subclinical ON lesions in RIS using MRI, OCT, and VEP.
  • To evaluate the diagnostic and prognostic significance of these ON lesions.
  • To compare the performance of the 2024 McDonald criteria with and without ON assessment.

Main Methods:

  • A retrospective, multicenter study of 179 RIS individuals (2023 RISC criteria).
  • Evaluation of diagnostic performance of 2024 McDonald criteria (with/without ON assessment) vs. 2017 criteria.
  • Analysis of associations between ON lesions, clinical conversion, comorbidities, and MRI activity using multivariate models.

Main Results:

  • Subclinical ON lesions were present in 59.8% of RIS individuals, primarily detected by VEP (61.0%) and OCT (58.5%), with MRI identifying only 18.7%.
  • No correlation was found between ON lesions (presence, laterality, number) and clinical conversion, event type, or MRI activity.
  • Younger age and absence of comorbidities predicted conversion, independent of ON lesions. Including ON in the 2024 McDonald criteria increased sensitivity but decreased specificity.

Conclusions:

  • Subclinical ON lesions are frequent in RIS, predominantly identified by OCT and VEP.
  • These lesions do not predict clinical conversion and may reduce the specificity of diagnostic criteria.
  • A multimodal assessment approach is recommended for RIS, with cautious interpretation of ON findings.