{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:26:42Z","timestamp":1790422002999,"version":"4.1.0"},"reference-count":19,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2025,9,21]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Optic neuritis (ON) has over 60 distinct causes, only one of which is multiple sclerosis (MS). This poses a challenge for its prompt and accurate diagnosis. Patients frequently present with pain that worsens on eye movements, followed by reduced colour vision and acuity, progressing over a couple of weeks. The recovery phase typically follows a similar pattern, with pain improving before visual function. The interpretation of relevant investigations depends on their timing. This paper presents a practical approach to investigating, diagnosing and classifying ON in individuals with MS and other common neuroinflammatory conditions. We have taken into account the most recent consensus panel diagnostic criteria for ON (2022), neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD, 2023) and MS (2024 revisions of the McDonald criteria). We use case histories to illustrate how best to use MRI and optical coherence tomography (OCT) in ON and discuss common clinical pitfalls.<\/jats:p>","DOI":"10.1136\/pn-2025-004702","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T19:00:23Z","timestamp":1763665223000},"page":"237-245","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnosing optic neuritis in the changing landscape of diagnostic criteria"],"prefix":"10.1136","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9244-5230","authenticated-orcid":false,"given":"Josef","family":"Penkava","sequence":"first","affiliation":[{"name":"Institute of Clinical Neuroimmunology, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"FRCP FRCOp","given":"Axel","family":"Petzold","sequence":"additional","affiliation":[{"name":"National Hospital for Neurology and Neurosurgery, London, England, UK"},{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"2026051402150821000_26.3.237.1","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/S1474-4422(25)00270-4","article-title":"Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria","volume":"24","author":"Montalban","year":"2025","journal-title":"Lancet Neurol"},{"key":"2026051402150821000_26.3.237.2","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(22)00431-8"},{"key":"2026051402150821000_26.3.237.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11634-0"},{"key":"2026051402150821000_26.3.237.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00200-9"},{"key":"2026051402150821000_26.3.237.5","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(21)00218-0"},{"key":"2026051402150821000_26.3.237.6","doi-asserted-by":"crossref","first-page":"e527","DOI":"10.1212\/WNL.0000000000006873","article-title":"Optical coherence tomography is highly sensitive in detecting prior optic neuritis","volume":"92","author":"Xu","year":"2019","journal-title":"Neurology"},{"key":"2026051402150821000_26.3.237.7","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70168-X"},{"key":"2026051402150821000_26.3.237.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjno-2025-001118","article-title":"Optic nerve as a 5th location in the revised McDonald diagnostic criteria for multiple sclerosis: limitations of OCT in the acute phase","volume":"7","author":"Mauceri","year":"2025","journal-title":"BMJ Neurol Open"},{"key":"2026051402150821000_26.3.237.9","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1038\/s41433-024-03164-4","article-title":"How far should I manage acute optic neuritis as an ophthalmologist? A United Kingdom perspective","volume":"38","author":"Laviers","year":"2024","journal-title":"Eye (Lond)"},{"key":"2026051402150821000_26.3.237.10","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2025.1605075","article-title":"Optic neuritis: a comprehensive review of current therapies and emerging treatment strategies","volume":"16","author":"Chaitanuwong","year":"2025","journal-title":"Front Neurol"},{"key":"2026051402150821000_26.3.237.11","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s10072-024-07895-w","article-title":"Review of atypical optic neuritis","volume":"46","author":"\u017dori\u0107","year":"2025","journal-title":"Neurol Sci"},{"key":"2026051402150821000_26.3.237.12","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000002774"},{"key":"2026051402150821000_26.3.237.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0034823","article-title":"The OSCAR-IB consensus criteria for retinal OCT quality assessment","volume":"7","author":"Tewarie","year":"2012","journal-title":"PLoS One"},{"key":"2026051402150821000_26.3.237.14","doi-asserted-by":"crossref","first-page":"4237","DOI":"10.1007\/s00415-024-12335-y","article-title":"Applying the 2022 optic neuritis criteria to noninflammatory optic neuropathies with optic nerve T2-hyperintensity: an observational study","volume":"271","author":"Labella \u00c1lvarez","year":"2024","journal-title":"J Neurol"},{"key":"2026051402150821000_26.3.237.15","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000200291","article-title":"Diagnostic Value of Inter-Eye Difference Metrics on OCT for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis","volume":"11","author":"Volpe","year":"2024","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2026051402150821000_26.3.237.16","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000001068","article-title":"Retinal Optical Coherence Tomography in Neuromyelitis Optica","volume":"8","author":"Oertel","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2026051402150821000_26.3.237.17","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12540-9"},{"key":"2026051402150821000_26.3.237.18","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000207805","article-title":"Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria: A Longitudinal, Prospective, Multicenter Study","volume":"102","author":"Vidal-Jordana","year":"2024","journal-title":"Neurology"},{"key":"2026051402150821000_26.3.237.19","doi-asserted-by":"crossref","unstructured":"Ning Neo Y , Martinez-Alvarez L , Davagnanam I , et al . Treatment of post-vaccination optic neuritis: implications from the global 2020\u20132021 SARS-CoV-2 vaccination effort. Graefes Arch Clin Exp Ophthalmol 2025 (in press). doi:10.1007\/s00417-025-06805-w","DOI":"10.1007\/s00417-026-07129-z"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2025-004702","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T09:16:22Z","timestamp":1778750182000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2025-004702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,5,14]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/pn-2025-004702"],"URL":"https:\/\/doi.org\/10.1136\/pn-2025-004702","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]}}}