AUTHOR=Nguyen Minh N. L. , Zhu Chao , Kolbe Scott C. , Butzkueven Helmut , White Owen B. , Fielding Joanne , Kilpatrick Trevor J. , Egan Gary F. , Klistorner Alexander , van der Walt Anneke 

TITLE=Early predictors of visual and axonal outcomes after acute optic neuritis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.945034

DOI=10.3389/fneur.2022.945034

ISSN=1664-2295

ABSTRACT=Background:  Predicting long term visual outcomes and axonal loss following acute optic neuritis (ON) is critical for choosing treatment. Predictive models including all clinical and paraclinical measures of optic nerve dysfunction following ON are lacking.  

Objectives: Using a prospective study method, to identify 1 and 3 month predictors of 6 and 12 month visual outcome (low contrast letter acuity 2.5%) and axonal loss (retinal nerve fibre layer thickness and multifocal evoked potential (mfVEP) amplitude) following acute ON.

Methods: 37 patients within 14 days of acute ON onset were evaluated using between-eye asymmetry of visual acuity, colour vision (Ishihara plates), optical coherence tomography, mfVEP and optic nerve magnetic resonance imaging (magnetic transfer ratio (MTR) and diffusion tensor imaging (DTI)). 

Results:  Visual outcome at 6 and 12 months was best predicted by Ishihara asymmetry at 1 and 3 months following ON onset.  Axonal loss at 6 and 12 months was reliably predicted by Ishihara asymmetry at 1 month. Optic nerve MTR and DTI at 3 months post-acute ON could predict axonal loss at 6 and 12 months.
Conclusions:  Simple Ishihara asymmetry testing 1 month after acute ON onset can best predict visual outcome and axonal loss at 6 and 12 months in a clinical or research setting