Predicting the Final Clinical Phenotype after the First Attack of Optic Neuritis
Shlok Sarin1, Nikhil Modak2, Rongyi Sun1, Omar Subei3, Alessandro Serra2, Michael Morgan2, Hesham Abboud2
1Case Western Reserve University School of Medicine, 2University Hospitals Cleveland Medical Center, 3Duke University
Objective:
To evaluate the factors determining the final clinical phenotype after an initial isolated attack of optic neuritis (ON).
Background:
ON could be an isolated event or the initial presentation of a chronic neuroimmunological condition. Predicting the eventual clinical phenotype at the time of initial attack can facilitate prognostication and inform management.
Design/Methods:
This was a retrospective analysis of patients presenting to University Hospitals Cleveland Medical Center for an initial, isolated attack of ON. Final clinical phenotypes were idiopathic ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disease (MOGAD), or secondary ON (e.g. neurosarcoidosis). Univariate analysis was carried out to determine predictors of the final clinical phenotype.
Results:
Sixty-four patients met criteria. Average age of onset was 41.3±13.3, 78.1% of patients were females, average time to final diagnosis was 8.3 months, and average follow-up was 47 months. The final phenotypes were MS (22, 34%), idiopathic ON (14, 22%), MOGAD (11, 17%), NMOSD (10, 16%), and secondary ON (7, 11%). Univariate analysis showed white race, unilateral ON, short segment hyperintensity on orbital MRI, and not receiving PLEX was associated with MS. Older age, poor steroid responsiveness, and receiving PLEX was associated with NMOSD. African American race, bilateral ON, papillitis on fundoscopy, and long segment hyperintensity on orbital MRI was associated with MOGAD. Normal or thinned retinal nerve fiber layer on OCT and short segment hyperintensity on orbital MRI were associated with idiopathic ON. The initial visual acuity did not differentiate between final phenotypes at the time of initial presentation.
Conclusions:
The final clinical phenotype may be predictable at the time of initial ON presentation. This requires a careful evaluation of patient demographics, treatment response, and findings on fundoscopy, OCT, and orbital MRI. Utilizing early predictors in clinical practice could better inform prognosis and management decisions.