The supporting role of Visual Evoked Potentials for the diagnosis of Optic Neuritis within the 2022 ICON criteria

BACKGROUND: Visual evoked potentials (VEPs) are commonly used in the assessment of optic neuritis (ON) but were not included in the International Consortium for ON (ICON) 2022 diagnostic criteria as supporting tests. OBJECTIVES: We aimed to assess VEPs diagnostic performances and their addition to the ICON criteria in a large consecutive cohort of patients with suspected ON. METHODS: We screened 207 patients with suspected ON and included 71 who performed MRI, OCT, and VEPs within 30 days from symptoms onset. We calculated diagnostic performances for each test and for the ICON 2022 criteria with and without the addition of VEPs. RESULTS: VEPs had high overall accuracy (88.7%; 95% confidence interval [CI]: 79.0-95.0) and area under the curve in the ROC analysis (0.89, CI: 0.82-0.97]). The addition of VEPs to the ICON 2022 criteria led to an improvement in sensitivity (100.0%, CI: 92.5-100.0), PPV (88.7%, CI: 79.6-94.0) and NPV (100%, CI: 78.2-100.0), maintaining the same specificity (75.0%, CI: 53.2-90.2), improving diagnostic accuracy to 91.5% (CI: 82.5-96.8). CONCLUSIONS: VEPs are reliable for the assessment of suspected ON, and they could be considered as a further paraclinical test in the ICON criteria.