Optic neuritis and autoimmune optic neuropathies: advances in diagnosis and treatment.

Optic neuritis is an inflammatory optic neuropathy that is commonly indicative of autoimmune neurological disorders including multiple sclerosis, myelin-oligodendrocyte glycoprotein antibody-associated disease, and neuromyelitis optica spectrum disorder. Early clinical recognition of optic neuritis is important in determining the potential aetiology, which has bearing on prognosis and treatment. Regaining high-contrast visual acuity is common in people with idiopathic optic neuritis and multiple sclerosis-associated optic neuritis; however, residual deficits in contrast sensitivity, binocular vision, and motion perception might impair vision-specific quality-of-life metrics. In contrast, recovery of visual acuity can be poorer and optic nerve atrophy more severe in individuals who are seropositive for antibodies to myelin oligodendrocyte glycoprotein, AQP4, and CRMP5 than in individuals with typical optic neuritis from idiopathic or multiple-sclerosis associated optic neuritis. Key clinical, imaging, and laboratory findings differentiate these disorders, allowing clinicians to focus their diagnostic studies and optimise acute and preventive treatments. Guided by early and accurate diagnosis of optic neuritis subtypes, the timely use of high-dose corticosteroids and, in some instances, plasmapheresis could prevent loss of high-contrast vision, improve contrast sensitivity, and preserve colour vision and visual fields. Advancements in our knowledge, diagnosis, and treatment of optic neuritis will ultimately improve our understanding of autoimmune neurological disorders, improve clinical trial design, and spearhead therapeutic innovation.

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Declaration of interests JLB reports payment for consultation from MedImmune/Viela Bio/Horizon Therapeutics, Alexion, Chugai, Clene Nanomedicine, Genentech, Genzyme, Mitsubishi Tanabe Pharma, Reistone Biopharma, Beigene, and Roche; personal fees from AbbVie; grants from Novartis, Mallinckrodt, and Alexion; data safety monitoring board work for Roche–Genentech and Clene Nanomedicine; and has a patent for aquaporumab issued. FC reports payment for consultation from Roche, Alexion, and Frequency Therapeutics, and speakers' fees from Accure Therapeutics, Alexion, Neurodiem, and the Sumaira Foundation. JJC reports payment for consultation from UCB, Horizon, and Roche. AP received grant support for remyelination trials in multiple sclerosis for the Amsterdam University Medicam Centre, Department of Neurology, Multiple Sclerosis Centre (RESTORE trial), University College London (RECOVER trial), and Fight for Sight (nimodipine in optic neuritis trial); received royalties or licences from Up-to-Date (Wolters Kluver) on a book chapter; received speaker fees for the Heidelberg Academy; participates on advisory board for SC Zeiss OCTA Angi-Network, Novartis OCTiMS study; holds leadership roles for governing board IMSVISUAL; is chairman of ERN-EYE Neuro-ophthalmology (until October, 2020), board member of National Dutch Neuro-ophthalmology Association; received equipment from OCT angiography from Zeiss (Plex Elite); and received medical writing support from Novartis for a manuscript. SLG reports payment for consultation from Biogen and Genentech. VB is a consultant for GenSight Biologics and Neurophoenix, and receives research support from GenSight Biologics and Santhera/Chiesi. NJN is a consultant for GenSight Biologics, Santhera/Chiesi, Stealth Biotherapeutics, and Neurophoenix; receives research support from GenSight Biologics and Santhera/Chiesi; is a participant in educational webinars sponsored by WebMD-Global Medscape and First Class; and is a medical-legal consultant in matters not related to this work.