When would you obtain optic nerve testing in patients suspected to have multiple sclerosis without a clinical history of optic neuritis?

A key change in the 2024 revision of the McDonald criteria is the addition of the optic nerve as a fifth anatomic location to demonstrate dissemination in space (DIS) in addition to periventricular, cortical/juxtacortical, infratentorial, and spinal cord, which were included in the 2017 criteria. Op...

Occasionally, to pick up subclinical disease in making an early diagnosis, I will request pattern-shift VEP. Picking up a silent lesion can help with the "dissemination in space" criteria, now that the optic nerve is considered part of the topography for MS lesion location in the new diagnostic crit...

One should start with perimetry. After analysis, OCT and or MRI can be specifically added. MRI is not sensitive except in the acute/subacute phase. OCT findings are non-specific, as are VEP findings. A neuro-op exam coupled with some testing is the best way to be sure any lesion is related to a pote...

Assuming it's acute optic neuritis, start with the basics:

1. Swinging flashlight test to screen for an afferent pupillary defect.
2. Assess red desaturation with a Tropicamide bottle cap (which neurologists sadly don't carry).
3. Dilated fundus exam to screen for papillitis/maculopathy/increased cup-disk r...