Treatment of post-vaccination optic neuritis: implications from the global SARS-CoV-2 vaccination effort

TL;DR

This study examines optic neuritis following SARS-CoV-2 vaccination, showing that early corticosteroid treatment improves outcomes and highlights the importance of timely intervention.

Contribution

A global prospective cohort study using novel diagnostic criteria reveals that post-vaccination optic neuritis is treatable with favorable outcomes when treated early.

Findings

Post-vaccination optic neuritis often occurs after the first dose and is frequently bilateral.

Early corticosteroid treatment preserves retinal layers and improves visual recovery.

Autoantibodies to MOG were present in 22% of cases, with no AQP4 autoantibodies detected.

Abstract

Optic neuritis (ON) is a rare but treatable side effect of vaccination. The global vaccination effort to SARS-CoV-2 offered a unique chance to study post-vaccination ON.

A one-year, prospective, multi-center follow-up study by the International Consortium for ON (ICON) in specialized neuro-ophthalmological clinical centers. The pre-specified protocol was confirm with the international consensus diagnostic criteria for making a diagnosis of definite ON. The main outcome measures were speed of treatment initiation, best corrected high contrast visual acuity and retinal asymmetry metrics on optical coherence tomography indicating atrophy.

Inclusion of 73 individuals from 15 countries with ON following SARS-CoV-2 vaccination. There were notable differences in characteristics of post-vaccination ON meeting diagnostic criteria compared to pre-COVID19 pandemic incidence studies. These included more frequent bilateral presentation 17/69 (25%) and older age at onset. Post-vaccination ON mostly manifested after the first vaccine dose in 58 individuals (84%). The most frequent (78%) presenting symptom was pain which worsened on eye movements. Twenty-two percent had autoantibodies to MOG and none to AQP4. Initial median visual acuity was logMAR 1.0, improving to logMAR 0.0 at one-year follow-up. Early corticosteroid treatment significantly preserved retinal nerve fiber, macular ganglion cell, and inner nuclear layers compared to later or no treatment.

Functional visual recovery in post-vaccination ON cases is good. Rapid treatment with corticosteroids provides neuroprotection, underscoring the need for timely intervention. Long-term management depends on presence of autoantibodies.

What is known
Post-vaccination optic neuritis (ON) was previously considered a rare, anecdotal occurrence before the COVID-19 pandemic.Retrospective database studies conducted after the pandemic identified ON as the second most common vaccine-related complication affecting vision.

Post-vaccination optic neuritis (ON) was previously considered a rare, anecdotal occurrence before the COVID-19 pandemic.

Retrospective database studies conducted after the pandemic identified ON as the second most common vaccine-related complication affecting vision.

What is new
A prospective, deeply phenotyped global cohort of post-vaccination ON was studied using a pre-specified protocol and novel consensus diagnostic criteria.Longitudinal data demonstrated excellent recovery of visual function, despite measurable atrophy in the retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) on optical coherence tomography (OCT).Evidence supports that rapid initiation of corticosteroid treatment helps preserve the RNFL and GCL, highlighting this as a treatable condition with favorable outcomes when managed promptly.

A prospective, deeply phenotyped global cohort of post-vaccination ON was studied using a pre-specified protocol and novel consensus diagnostic criteria.

Longitudinal data demonstrated excellent recovery of visual function, despite measurable atrophy in the retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) on optical coherence tomography (OCT).

Evidence supports that rapid initiation of corticosteroid treatment helps preserve the RNFL and GCL, highlighting this as a treatable condition with favorable outcomes when managed promptly.

The online version contains supplementary material available at 10.1007/s00417-025-06805-w.

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