Petzold, Axel;
(2025)
Re-classification of Optic Neuritis.
Presented at: Neurophthalmology Update for Clinicians, Rome, Italy.
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Abstract
Optic neuritis (ON) represents a critical intersection between ophthalmology, neurology, and immunology, frequently the first manifestation of systemic autoimmune disease and a source of diagnostic uncertainty. This Magistral Lecture presents the ICON 2022 diagnostic criteria for optic neuritis, a consensus framework developed to standardise the diagnosis of ON using rigorous clinical and paraclinical standards. Emphasising clarity and practicality, the lecture introduces the ICON two-level classification system, designed to guide real-world clinical decisions. Level 1 of this classification serves a pragmatic purpose: to determine whether a patient should be referred for long-term immunosuppressive therapy and subspecialist evaluation, or whether recovery from a monophasic episode allows for safe discharge and monitoring. Level 2 delves deeper into the autoimmune subtypes of ON, such as those associated with MS, NMOSD, and MOGAD, where relapsing disease patterns and targeted therapies demand more nuanced management. This practically motivated classification approach will be contrasted with traditional taxonomies that emphasize pathological uniformity across ON presentations. Clinical case discussions will be used to illustrate the consequences of both models in real-life diagnostic and treatment scenarios. The lecture will further review alternative approaches to ON classification, including systems based on disease course, anatomical localisation, epidemiological subgroups, and diagnostic performance metrics. Special attention will be given to validation studies aimed at improving diagnostic sensitivity and specificity, with the goal of achieving a balance between early detection and clinical precision. Throughout, the patient perspective will remain central. Testimonies and lived experiences will underscore the personal and emotional dimensions of ON diagnosis, highlighting what ultimately matters to those living with this complex condition. The session will conclude with an update on the global growth and impact of the ICON network, now spanning over 500 experts in more than 60 countries. The ICON initiative continues to expand its vision: from criteria and classification to care pathways and collaborative trial design, offering a scalable, interdisciplinary model for rare neuroimmunological diseases.
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