Cooperation between ophthalmologist and neurologist in visual disturbances in patients with multiple sclerosis Review article

Abstract

According to the latest 2024 revision of the McDonald criteria, the optic nerve has been included as the fifth typical localization of lesions in multiple sclerosis. This change enables the demonstration of dissemination in space and facilitates an earlier diagnosis, allowing for faster initiation of immunomodulatory treatment in patients with multiple sclerosis. Given the frequent involvement of the optic nerve in multiple sclerosis (in 25–30% of patients as the first manifestation in clinically isolated syndrome and in up to 70% during the course of the disease), it is now possible to consider inflammatory lesions in the optic nerve (on magnetic resonance imaging), retinal layer thinning (on optical coherence tomography), or prolonged P100 latency (on visual evoked potentials) as indicators of optic pathway involvement in the demyelinating process of the central nervous system. Ophthalmological assessment, including optical coherence tomography evaluation of retinal thinning, is crucial from the neurologist’s perspective for both differential diagnosis and monitoring treatment efficacy. High-efficacy treatments in multiple sclerosis have been shown to be more effective in preventing retinal thinning and optic nerve neurodegeneration than moderate-efficacy therapies.