Optic neuritis post SARS‐CoV‐2 infection and vaccination; a systematic review exploring the clinical features of optic neuritis after SARS‐CoV‐2 infection and vaccination

Abstract

Aims/Purpose: This study aims to characterize the symptoms and clinical features of Optic Neuritis (ON) following SARS‐CoV‐2 infection and vaccination.Methods: A literature search was conducted in 4 databases (Pubmed, Medline, Embase, Google Scholar) to identify relevant case reports and case series. The records were screened and articles adhering to the inclusion criteria were critically appraised.Results: Sixty‐eight studies were found to be eligible for inclusion, including 34 reporting ON following SARS‐CoV‐2 infection and an equal number reporting cases post vaccination. In total 93 patients and 125 eyes were included. The infection cohort included 42 patients and 56 eyes, 48.8% were female and 33.3% experienced bilateral ON. The mean visual acuity was 1.64 LogMAR, while pain was present in 75%. Oligoclonal bands were present in 3 patients, MOG antibodies in 18, and AQP‐4 antibodies in 4. The vaccination cohort included 51 patients and 69 eyes. 60.8% were female and 35.3% had a bilateral ON. The mean visual acuity was 0.93 LogMAR. Oligoclonal bands were present in 46.7%, MOG antibodies in 9 patients and AQP‐4 antibodies in 3.Conclusions: Patients with ON post SARS‐CoV infection were more likely to experience severe visual impairment than in cases following vaccination. Further research is required to outline the clinical features of ON after COVID‐19 infection and vaccination, and establish causality.