Optic nerve as a 5th location in the revised McDonald diagnostic criteria for multiple sclerosis: limitations of OCT in the acute phase
Open accessAbstract
Background: The updated International Panel’s diagnostic criteria for multiple sclerosis (2024 revision of McDonald criteria) have for the first time included the optic nerve as the fifth location for dissemination in space (DIS) criterion. The new requirement consists of evidence of significant retinal asymmetry. However, this can be challenging in the acute phase in absence of optic disc swelling. Here, we have investigated the sensitivity of retinal asymmetry over time, from the acute to the chronic phase of optic neuritis. Methods: This observational study analysed longitudinal optical coherence tomography (OCT) images of 25 patients with optic neuritis and 5 healthy controls. Spectral domain OCT scans were obtained from the macula and optic disc. The peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell (mGCL) and inner plexiform layers (mIPL) were measured in the acute (≤7 days), subacute (between 1 and 12 weeks) and chronic (>3 months) phase. Results: The OCT measurements showed progressive thinning in pRNFL and mGCIPL layers as the disease progressed. In the acute phase, the sensitivity of the pRNFL was 69% (due to optic disc swelling) and for the mGCPL 27%. In the chronic phase, sensitivity levels increased up to 76% (pRNFL) and 88% (mGCIPL) due to atrophy. Conclusions: A clear understanding of the temporal dynamics of diagnostic findings is important. For OCT, the highest diagnostic sensitivity is achieved for the mGCIPL in the chronic phase. This should be taken into account for timing the test in patients where the acquisition of optic nerve involvement is essential for DIS.
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OCT is emerging as a robust prognostic biomarker in MS and was also suggested to be applicable for treatment decisions and differential diagnosis.
“Further, OCT is emerging as a robust prognostic biomarker in MS and was also suggested to be applicable for treatment decisions and differential diagnosis.”
From Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany (2026) · cites this paper as [40]
The Discussion describes OCT as a tool for MS diagnosis and disease monitoring, and notes that optic neuritis from different causes may follow distinct structural trajectories. It does not establish OCT as a robust prognostic biomarker or suggest its use for treatment decisions; it also cautions against applying MS-specific diagnostic cut-offs during the acute phase. No page numbers are provided in our copy. (LLM, conf=0.84)
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Research works printed but not linked: 16
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Konen, F. F., Mahmoudi, N., Albers, L. M., Arrambide, G., Streichert, A. L., Haar, M., Soldatov, A., Bucak, E., Jendretzky, K. F., Nay, S., et al. (2026) · eClinicalMedicine · doi:10.1016/j.eclinm.2026.104098
“,38–40 The last main finding of the present study is that need for novel MRI markers (CVS, PRL) is limited to a low number of patients, whenever the conventional routine diagnostic as proposed for the 2017-revised McDonald criteria are employed and results are available.”
Self-citation
- Authors
- Mauceri, V. A., Puthenparampil, M., Gallo, P., & Petzold, A.
- Affiliations
- University of Padua (IT)
- Moorfields Eye Hospital (GB)
- Corresponding author
- Mauceri, Valentina Annamaria
- Venue
- BMJ Neurology Open
- Publisher
- BMJ
- Published
- 2025-07
- Volume
- 7
- Issue
- 2
- Pages
- e001118
- ISSN
- 2632-6140 (ISSN-L)
- PMC
- PMC12481384
- OpenAlex
- W4414612194
- Cited by
- 7
- References
- 0
- Citations by year
- 2026: 5 · 2025: 2
- FWCI
- 4.65
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- BMJ Neurology Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Ophthalmology › Glaucoma and retinal disorders
- Health Sciences › Medicine › Ophthalmology › Retinal and Optic Conditions
- Keywords
- multiple sclerosis, optic nerve involvement, dissemination in space, optic neuritis, optical coherence tomography, peripapillary retinal nerve fiber layer, macular ganglion cell-inner plexiform layer, optic disc edema, diagnostic sensitivity, disease progression
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