• Young Gi Min, Yeji Moon, Young Nam Kwon, Byung Joo Lee, Kyung-Ah Park, Jae Yong Han, Jinu Han, Haeng-Jin Lee, Seol-Hee Baek, Byung-Jo Kim, Jun-Soon Kim, Kyung Seok Park, Nam-Hee Kim, Martha Kim, Tai-Seung Nam, Seong-Il Oh, Jae Ho Jung, Jung-Joon Sung, Myoung-Jin Jang, Seong-Joon Kim, and Sung-Min Kim.
• Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).
• J. Neurol. Neurosurg. Psychiatr. 2024 Jul 15; 95 (8): 753760753-760.

BackgroundOptic neuritis (ON) prognosis is influenced by various factors including attack severity, underlying aetiologies, treatments and consequences of previous episodes. This study, conducted on a large cohort of first ON episodes, aimed to identify unique prognostic factors for each ON subtype, while excluding any potential influence from pre-existing sequelae.MethodsPatients experiencing their first ON episodes, with complete aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing, and clinical data for applying multiple sclerosis (MS) diagnostic criteria, were enrolled. 427 eyes from 355 patients from 10 hospitals were categorised into four subgroups: neuromyelitis optica with AQP4 IgG (NMOSD-ON), MOG antibody-associated disease (MOGAD-ON), ON in MS (MS-ON) or idiopathic ON (ION). Prognostic factors linked to complete recovery (regaining 20/20 visual acuity (VA)) or moderate recovery (regaining 20/40 VA) were assessed through multivariable Cox regression analysis.ResultsVA at nadir emerged as a robust prognostic factor for both complete and moderate recovery, spanning all ON subtypes. Early intravenous methylprednisolone (IVMP) was associated with enhanced complete recovery in NMOSD-ON and MOGAD-ON, but not in MS-ON or ION. Interestingly, in NMOSD-ON, even a slight IVMP delay in IVMP by >3 days had a significant negative impact, whereas a moderate delay up to 7-9 days was permissible in MOGAD-ON. Female sex predicted poor recovery in MOGAD-ON, while older age hindered moderate recovery in NMOSD-ON and ION.ConclusionThis comprehensive multicentre analysis on first-onset ON unveils subtype-specific prognostic factors. These insights will assist tailored treatment strategies and patient counselling for ON.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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