NeuroOp Guru at AAO 2026: Blurry vision in MS isn’t always a relapse

In this episode of NeuroOp Guru in collaboration with Ophthalmology Times, recorded at the American Academy of Ophthalmology 2026 Annual Meeting in New Orleans, host Andrew G. Lee, MD, is joined by Drew Carey, MD, to discuss a multi-institutional cohort study examining the association between optic neuritis and uveitis in patients with central nervous system (CNS) demyelinating disorders.¹

Lee is the chair of the Blanton Eye Institute at Houston Methodist Hospital and a professor of ophthalmology, neurology, and neurosurgery at the Weill Cornell Medical College. Carey is the Neil R. Miller Rising Professor of Ophthalmology in the division of neuro-ophthalmology with the Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore, Maryland.

Why optic neuritis and uveitis may travel together

Carey explained that several conditions can cause both optic neuritis and uveitis, and that the study focused on patients with CNS demyelinating disorders.

The best known of these is multiple sclerosis (MS), but the group also included neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD). Carey said they have “underlying mechanisms that can cause inflammation in the brain, the optic nerve, and the eye.”¹

What the data showed

The study authors conducted a retrospective analysis using the TriNetX database of US health care data. They first identified patients with a CNS demyelinating condition, then compared those with and without optic neuritis using propensity score matching.¹

The researchers looked at 5-year cumulative incidence of uveitis in both groups. They found that “patients who had optic neuritis due to a CNS demyelinating condition had about twice the risk of having uveitis compared with patients with CNS demyelinating condition who’d never had optic neuritis,” Carey said. In the study, 5-year uveitis risk was 1.1% in the optic neuritis group vs 0.6% in the comparison group (hazard ratio [HR], 2.0), and intermediate uveitis carried the highest risk (HR, 3.8).¹

Asked by Lee whether the finding depended on MS, Carey said, “all comers had pretty similar rates.” He added, “Obviously, MS being the most common was the one they had the most data for. But it was similar for the MS group, the NMO [NMOSD], and the MOGAD group.”

When blurry vision isn’t just a relapse

Carey said the take-home message is “if you have a patient who’s had MS and optic neuritis, and they call your office saying, ‘I have blurry vision,’ it may not just be optic neuritis relapse.” Clinicians should not automatically send these patients to the emergency department for intravenous (IV) steroids. “They need to come in,” he said.

The eye exam should look for a new relative afferent pupillary defect and color vision loss. It should also check for intraocular inflammation. “Is there color vision loss, or are there cells in the eye that we can be treating with local instead of IV steroids?” Carey asked.

Reference

1. Surgent-Nahay JL, Chauhan MZ, Kwok AS, et al. The association between uveitis and optic neuritis in central nervous system demyelinating disorders: a multi-institutional cohort study. J Neuroophthalmol. 2026;46(3):350-356. doi:10.1097/WNO.0000000000002462