Changepoint analysis of longitudinal OCT in optic neuritis: Structural stabilization dynamics and clinical correlates

To determine the timing of structural stabilization ("changepoint") in peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thinning after optic neuritis (ON), and to evaluate associated clinical predictors and prognostic significance.

In this retrospective cohort study, 70 eyes from 56 patients with ON, including aquaporin-4 antibody-positive ON (AQP4-ON), myelin oligodendrocyte glycoprotein antibody-positive ON (MOG-ON), multiple sclerosis-associated ON (MS-ON), and idiopathic ON (iON), were analyzed. Longitudinal pRNFL and mGCIPL thickness were interpolated at fixed time intervals. The changepoint was defined as the earliest time point when layer thickness matched the stable-phase slope within the test-retest threshold (3µm for pRNFL, 2µm for mGCIPL). Clinical correlates and 1-year visual outcomes were assessed.

Mean changepoints were 4.3 ± 1.2 months for pRNFL and 3.4 ± 1.2 months for mGCIPL. MOG-ON showed significantly later pRNFL stabilization than the other subtypes of ON. Younger age and longer onset-to-steroid interval were associated with later pRNFL changepoints. For mGCIPL, delayed stabilization was associated with younger ange, worse baseline VA, and longer onset-to-steroid interval. Delayed mGCIPL changepoints correlated with poorer 1-year outcomes, including worse VA, lower MD, and reduced VFI.

mGCIPL stabilizes earlier than pRNFL after ON, and its changepoint timing reflects baseline injury severity, treatment delay and predicts visual outcomes. Changepoint-based OCT analysis provides a quantitative framework to monitor ON disease dynamics and suggests the importance of early anti-inflammatory therapy to limit neuronal injury and improve long-term vision.