New study identifies how to diagnose common cause of vision loss

20 December 2022
Developing diagnostic criteria for optic neuritis
A study led by Dr Axel Petzold (UCL Queen Square Institute of Neurology, London), Prof Gordon Plant (National Hospital for Neurology, London) and A/Prof Clare Fraser (Save Sight Institute, Sydney) has developed diagnostic criteria for an eye condition known as optic neuritis that will help inform treatment options.

Optic neuritis, inflammation in the optic nerve, is a common cause of vision loss affecting people of any age. Sometimes optic neuritis is caused by Multiple Sclerosis but can also be triggered by many other conditions.

Prior to this publication there has been no consensus on how to diagnose optic neuritis, making it challenging to provide timely treatment for conditions in which it is the first symptom.

The research team recruited over 100 specialists from 60 countries to assess real life clinical scenarios. This enabled them to develop diagnostic criteria outlining clinical features that indicate possible optic neuritis. Further tests, including brain, orbital, and retinal imaging, together with biomarker data, could then be used to confirm a definite diagnosis of the condition.

We hope our classification will lead to the identification of yet more immunological causes of optic neuritis and ensure uniformity in identifying sub-types of optic neuritis.
Dr Petzold, UCL Queen Square Institute of Neurology, London

The cause and management of optic neuritis varies with geographical location, treatment availability and ethnic background. Historically, clinical research on optic neuritis has been carried out in Europe and North America and has therefore reports on diagnosis and management have been dominated by the disease profile of this demographic. In the study, the researchers achieved a 95% expert consensus through a Delphi process to categorise the links between optic neuritis and other antibody mediated disorders including syndromes such as Neuromyelitis Optica, or Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease, which are more common in patients of African and Asian origin.

The criteria developed by the researchers will reduce the risk of misdiagnosis and will be useful for informing treatment options. For example, the likelihood of a patient needing long-term pharmacological management may differ according to their subgroups of optic neuritis.

On the developments, Dr Fraser said, 'This is an important international collaboration, which expands our understanding and classification of all types of optic neuritis across the world.  We are hopeful that the criteria we have developed will lead to a consensus on how to design treatment trials for optic neuritis in the future.' 

Associate Professor Clare Fraser

Eye genetics and inherited retinal diseases group
View academic profile