Diagnostic yield of the 2022 optic neuritis criteria and an antibody-stratified adjunct in an antibody-predominant Chinese clinical sample.

BACKGROUND

The real-world performance of the 2022 international consensus criteria for optic neuritis (ICON) in antibody-predominant Chinese practice is uncertain. We evaluated diagnostic yield and an antibody-stratified adjunct for settings with high antibody prevalence and timely antibody testing.

METHODS

We retrospectively studied 151 consecutive patients admitted with acute optic neuritis between 2020 and 2023. All cases were reclassified using strict 2022 ICON. We then evaluated an assumed-dyschromatopsia scenario in which dyschromatopsia was assumed unless normal color vision was explicitly documented. On top of that scenario, we applied an antibody-stratified adjunct using aquaporin-4 immunoglobulin G (AQP4-IgG) seropositivity or clear-positive myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG; fixed cell-based assay titer ≥1:100) plus objective optic nerve evidence.

RESULTS

Strict 2022 ICON classified 30/151 (20%) cases as Definite ON, 113/151 (75%) as Possible ON, and 8/151 (5%) as Not ON. Under the assumed-dyschromatopsia scenario, Definite ON increased to 112/151 (74%). With the antibody-stratified adjunct, Definite ON further increased to 124/151 (82%), while Not ON remained 8/151 (5%). Definite ON reached 82/82 (100%) in AQP4-IgG-positive cases, 20/21 (95%) in MOG-IgG-positive cases, 18/37 (49%) in double-seronegative cases, and 4/11 (36%) in cases with incomplete AQP4-IgG/MOG-IgG testing.

CONCLUSIONS

In this antibody-predominant clinical sample, strict 2022 ICON yielded a low Definite ON classification rate, driven largely by incomplete bedside documentation, especially color vision assessment. Assuming complete dyschromatopsia documentation improved yield, and the antibody-stratified adjunct provided further gains without increasing the Not ON category.