Purpose To evaluate diffusion weighted imaging (DWI) with advanced diffusion models, optical coherence tomography (OCT), and automatic retinal oximetry as potential biomarkers for visual deficits after optic neuritis (ON).

Methods Twenty-five patients with acute unilateral ON underwent brain DWI, OCT, and oximetry at the treatment initiation, and 3 and 6 months later. Additionally, 56 healthy volunteers with normal vision were examined once. Clinical outcomes were best-corrected visual acuity (BCVA) and contrast sensitivity. Predictors included retinal nerve fiber layer (RNFL) thickness, arteriolar and venular oxygen saturation (AS, VS), and arterio-venous difference (AVD) in the affected eye as well as DWI parameters from both optic radiations.

Results Multivariate analysis of variance (MANOVA) for baseline DWI indicated higher secondary partial volume fraction (f2) in patients, while both groups exhibited significant left-right differences for all DWI parameters. Longitudinal analysis in 17 patients with follow-up data revealed a multivariate effect of time when adjusted for affected side and time since onset, however, no DWI parameters changed significantly on a univariate level. Stratified unadjusted model indicated lower overall fractional anisotropy (FA) in patients with incomplete recovery. On uncorrected level, baseline FA and oximetry (VS) were correlated with follow-up BCVA at month 6, while axonal diffusivity (AD) predicted follow-up VS and AVD. In turn, baseline VS and AVD predicted follow-up RNFL thickness.

Conclusions DWI and retinal oximetry are promising early predictors of visual function outcome after ON.

Translational Relevance DWI and retinal oximetry are potentially suitable for patient stratification in studies investigating novel therapeutic interventions.

The authors have declared no competing interest.

This work was supported by the Ministry of Health of the Czech Republic (grant number NV19-06-00216). This project has received funding from the European Union's Horizon Europe research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101107932 (fellowship awarded to Jan Valošek). Pavel Hok was awarded a Gerhard-Domagk fellowship by University Medicine Greifswald for undertaking this study.

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Approved by Ethics Committee of the University Hospital and the Faculty of Medicine and Dentistry, Palacky University in Olomouc, approval number NV19-06-00216.

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Funding: This work was supported by the Ministry of Health of the Czech Republic (grant number NV19-06-00216). This project has received funding from the European Union’s Horizon Europe research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101107932 (fellowship awarded to Jan Valošek). Pavel Hok was awarded a Gerhard-Domagk fellowship by University Medicine Greifswald for undertaking this study.

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Anonymized preprocessed data are available via a request to the corresponding author, following a formal data sharing agreement.