The Case for Including Optic Nerve Lesions in MS Dx Criteria
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The McDonald criteria for diagnosing multiple sclerosis (MS) has been around since 2001, with revisions in 2005, 2010, and 2017. They focus on lesions disseminated in space (DIS) and disseminated in time (DIT). As with any diagnostic, new science and methods inform changes. Although optic nerve lesions (ONL) have been considered in past revisions, they have yet to be adopted as a key diagnostic measure of MS.
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@jhilmil At the annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), several speakers made the case for the addition of ONL to the next McDonald revision. Arguments ranged from the inherent injustice that patients with a diagnosis of optic lesions should have to meet three symptoms of MS to get a diagnosis, while other patients require only two, to the possibility that early presentation with ocular symptoms could be an indicator of a more severe prognosis.