The neuro-ophthalmology of multiple sclerosis

In their interesting review, the neuro-ophthalmology of multiple sclerosis, Frohman and co-workers emphasise the importance distinguishing typical optic neuritis from other types of optic neuropathy. The authors describe differentiating features, including type of visual loss, age of the patient at onset, presence of pain, retinal findings, and type of visual field defect. I have developed a mnemonic to help remember the clinical characteristics of typical optic neuritis. The presentation of optic neuritis is with an acute onset of monocular visual loss. TYPICAL optic neuritis is characterised by: T = Transient visual loss (“down in days, up in months”) Y = Young adults (20–50 years) P = Pain with eye movements I = Inconspicuous ophthalmoscopic findings C = Central scotoma A = Afferent pupillary defect L = Leber’s hereditary optic neuropathy does not run in the family This mnemonic may help clinicians to decide whether optic neuritis is typical or not. I fully agree with Frohman and co-workers that a more aggressive assessment should be considered when non-typical features of optic neuritis are present.