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International panel proposes new criteria for diagnosing cause of ON

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A position paper published in The Lancet Neurology presents a new set of diagnostic criteria and classifications for optic neuritis. These updated diagnostic guidelines will undergo regular review and feedback. (via)

Give me a refresher on optic neuritis.

Optic neuritis is a common cause of vision loss that can be triggered by over 60 disorders, including but not limited to systemic disorders such as multiple sclerosis and Sjögren syndrome, as well as infectious and post-infectious causes like chickenpox, COVID-19, and Lyme disease.

Tell me about the new criteria.

These criteria were developed by an international panel of over 100 neurologists, neuro-ophthalmologists, ophthalmologists, and neuroradiologists between 2018-2021.

The paper presented a three-tier classification scheme. The first level addresses whether the diagnosis is relapsing or monophasic; the second addresses the optic neuritis subtypes that can fall into the relapsing category alongside a list of conditions associated with monophasia; and the third consists of the rare subtypes that are recognized but not associated with the second level.

Further details include the anatomical, biomarker, and chronological classifications of optic neuritis and the use of imaging and other tools for investigation. (via)

What does this mean for clinicians?

Up-to-date diagnostic criteria will arm eyecare professionals with best practice guidelines for diagnosing optic neuritis using all the tools at their disposal.

Further, accurate diagnosis can lead to timely treatment for individuals suffering from multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), or myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease.

Take home?

While the panel came to a 95% consensus on the top-level classification of optic neuritis, they did not reach a consensus over treatment options, claiming that “uncertainty remains for less extreme clinical presentations,” the authors noted. “In routine clinical practice, the less extreme cases are probably most common.”