Predicting Clinical Phenotypes and Optimizing Treatment for Optic Neuritis

Predicting Clinical Phenotypes and Optimizing Treatment for Optic Neuritis

A recent study published in the Journal of Neuroimmunology aimed to determine the final clinical phenotypes of optic neuritis (ON) in order to predict the neuroimmunological condition a patient will develop. The findings of the study can potentially help optimize treatment approaches for patients.

The research showed that idiopathic ON, multiple sclerosis (MS)-related ON, neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte antibody disease (MOGAD), and secondary ON were the final clinical phenotypes identified in the study cohort.

Several factors were associated with specific clinical phenotypes. Older age, poor steroid responsiveness, and receiving plasma exchange (PLEX) were associated with NMOSD. Black race, bilateral ON, papillitis on fundoscopy, and long-segment hyperintensity on orbital MRI were also associated with NMOSD. On the other hand, normal or thinned retinal nerve fiber layer on OCT and short-segment hyperintensity on orbital MRI were associated with idiopathic ON.

Visual acuity was found not to be predictive of the final clinical phenotype, contrary to previous beliefs. African Americans were more likely to have MOGAD-associated ON rather than NMOSD.

The implications of these findings are both therapeutic and prognostic. Early prediction of the clinical phenotype can help determine the appropriate treatment approach. For example, patients with MS and idiopathic disease may not require oral taper after acute therapy, while patients with MOGAD, NMOSD, and neurosarcoidosis may benefit from a long taper to prevent early recurrences.

Patients with NMOSD, who are often steroid-resistant, may require plasma exchange for recovery. Identifying potential NMOSD patients early can lead to timely treatment with plasma exchange, minimizing visual disability.

Further research is needed to study larger cohorts in a prospective manner to validate these findings. Advanced MRI and OCT techniques may also provide valuable insights in predicting clinical phenotypes and optimizing treatment for optic neuritis.

– Abel A, McClelland C, Lee MS. Critical review: Typical and atypical optic neuritis. Surv Ophthalmol. 2019;64(6):770-779.
– Kosiyakul P, Songwisit S, Ungprasert P, et al. Effect of plasma exchange in neuromyelitis optica spectrum disorder: A systematic review and meta-analysis. Ann Clin Transl Neurol. 2020;7(11):2094-2102.
– Sarin S, Modak N, Sun R, et al. Predicting the final clinical phenotype after the first attack of optic neuritis. J Neuroimmunol. 2023;381:578130.

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