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

Neo, Yan Ning; Martinez-Alvarez, Lidia; Davagnanam, Indran; Girafa, Gabriela; Bremner, Fion; Braithwaite, Tasanee; Khaleeli, Zhaleh; Nowak, Victoria; Toosy, Ahmed T.; Petzold, Axel

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

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Item Type:	Article
Title:	Treatment of post-vaccination optic neuritis: implications from the global SARS-CoV-2 vaccination effort
Creators Name:	Neo, Yan Ning, Martinez-Alvarez, Lidia, Davagnanam, Indran, Girafa, Gabriela, Bremner, Fion, Braithwaite, Tasanee, Khaleeli, Zhaleh, Nowak, Victoria, Toosy, Ahmed T. and Petzold, Axel
Abstract:	PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Keywords:	Optic Neuritis, Vaccination, Treatment, Outcome
Source:	Graefes Archive for Clinical and Experimental Ophthalmology
ISSN:	0721-832X
Publisher:	Springer
Volume:	264
Number:	3
Page Range:	851-862
Date:	29 November 2025
Additional Information:	Erratum in: Graefes Arch Clin Exp Ophthalmol. 2026 Mar;264(3):887. - Friedemann Paul is a member of the International Consortium on Optic Neuritis (ICON).
Official Publication:	https://doi.org/10.1007/s00417-025-06805-w
PubMed:	View item in PubMed

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