Evaluation of the 2022 international consensus criteria for optic neuritis: the role of clinical features and visual evoked potentials.

BACKGROUND AND AIM: Optic neuritis (ON) diagnosis is challenging due to variable clinical presentations and the limited prospective validation of current criteria. This study evaluates the 2022 international consensus criteria for optic neuritis (ICON) criteria, and the impact of adding visual evoked potentials (VEPs) and new clinical definitions to improve diagnostic accuracy. METHODS: We introduced modifications to the ICON 2022 criteria, including a less strict clinical category allowing ON diagnosis with incomplete clinical features and the incorporation of VEPs as an additional paraclinical test. We then prospectively studied 46 patients with a first episode of unilateral subacute ON. Alongside standard clinical, MRI, OCT, and laboratory assessments, diagnostic classifications were compared between the original and modified criteria. RESULTS: Using the original ICON 2022 criteria, 20 patients (43.5%) were classified as definite ON. This number increased to 32 patients (69.6%; p < 0.001) when applying the modified clinical criteria together with two abnormal paraclinical tests (MRI, OCT, or laboratory findings). When VEPs were incorporated alongside the less stringent clinical criteria, the number of definite ON cases further increased to 39 (84.8% vs. 43.5%; p < 0.001). CONCLUSION: The inclusion of VEPs, together with the adoption of less stringent clinical criteria, significantly increased the proportion of patients classified as having definite ON compared with the 2022 ICON criteria. This was particularly evident in patients with incomplete clinical presentations but typical paraclinical features, thereby supporting revisions aimed at broader clinical applicability.