Nerve loss occurs in optic neuritis

Maghzi AH, Graves J, Revirajan N, Spain R, Liu S, McCulloch CE, Pelletier D, Green AJ, Waubant E. Retinal axonal loss in very early stages of multiple sclerosis. Eur J Neurol. 2015 . doi: 10.1111/ene.12722. [Epub ahead of print]

BACKGROUND AND PURPOSE:The lack of surrogates of clinical progression has limited the design of neuroprotection trials in multiple sclerosis (MS). Our aim was to study the association between time-domain optical coherence tomography measures and clinical and magnetic resonance imaging outcomes in early MS.
METHODS: Forty-three relapsing-remitting MS patients within 1 year of onset were followed for up to 3 years.
RESULTS: The peripapillary retinal nerve fiber layer (RNFL) decreased annually by 2 μm (95% confidence interval -3.89, -0.11; P = 0.038). The RNFL tended to be associated with normalized normal appearing white matter volume in cross-sectional (P = 0.08) and longitudinal analyses (P = 0.06).
CONCLUSIONS: There is substantial RNFL loss even in very early MS. Our data suggest that retinal axonal atrophy is associated with atrophy in global white matter volume in early MS

We know that nerves get damaged during optic neuritis and that this occurs from the earliest stages and that occurs at the the onset of MS. The good news is that ProfG and Dr Kapoor showed that you can protect against this nerve loss by treating with a new protector. So the question posed was what next. They could try and see if this works in progression or see if it saves nerves after a relapse or alternatively maybe they should do the same thing again and show it works again and then maybe people with optic neuritis would get treated, people with optic neuritis would be less likely to lose sight, and ProfG and Kapoor will get an impact statement for their work in Ref 2020.