Immune-mediated optic neuritis: A historical perspective

Optic neuritis is an inflammatory optic neuropathy commonly associated with immune-mediated neurological diseases. Patients with optic neuritis typically present with subacute monocular vision loss, often with eye pain worsened by eye movement, and dyschromatopsia. Over the past 2 centuries, advances in science, including the development of the ophthalmoscope, magnetic resonance imaging, and optical coherence tomography, have improved our understanding and classification of optic neuritis. Landmark discoveries in neuroimmunology, such as the identification of aquaporin-4 antibodies in neuromyelitis optica and myelin oligodendrocyte glycoprotein antibodies in myelin oligodendrocyte glycoprotein antibody-associated disease, have established these conditions as distinct entities from multiple sclerosis, each with its own pathophysiological and therapeutic profiles. This disease distinction enabled the development of specific biomarker assays and novel immunotherapies. Major developments in medicine, including the synthesis of cortisone, the implementation of clinical trials, and the creation of targeted therapeutics with monoclonal antibodies, have dramatically improved patient outcomes over recent decades. In this work, we review the chronology of our understanding of immune-mediated optic neuropathies, from the elemental discoveries in optics to the advances in molecular diagnostics and neuroimaging.