This historical review traces the evolution of understanding and management of immune-mediated optic neuritis over two centuries, covering diagnostic advances (ophthalmoscope, MRI, OCT) and key neuroimmunology discoveries including AQP4 antibodies in NMOSD and MOG antibodies in MOGAD.
The identification of AQP4 and MOG antibodies established NMOSD and MOGAD as distinct entities from MS, enabling disease-specific biomarker assays and targeted monoclonal antibody therapies that have dramatically improved patient outcomes.
As a historical narrative review, it does not include primary data, statistical analyses, or a systematic literature search, limiting the ability to draw evidence-based clinical conclusions.
Clinicians should recognize NMOSD and MOGAD as pathophysiologically and therapeutically distinct from MS-associated optic neuritis, making AQP4 and MOG antibody testing essential in the workup of optic neuritis. Disease-specific immunotherapies now exist for each entity and should guide treatment decisions.
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