Interventions to prevent, treat, and minimize long-term visual impairment from optic neuropathy in people living with demyelinating diseases

Optic neuritis, inflammation of the optic nerve, leading to optic neuropathy, damage to the optic nerve, is a common feature of demyelinating disease. As many as 25% of individuals with multiple sclerosis (MS) first presenting in this manner. A longstanding goal of teams caring for patients with demyelinating disease has been to protect vision by avoiding the development of optic neuropathy and restoring visual deficits when episodes do occur. So called “neuroprotective” agents remain a holy grail in the field. Neuroprotection refers to efforts to preserve and recover cellular structure and function of the nervous system. This includes the concept of remyelination. Various approaches have been attempted over the years though as of this writing little progress has been made. We reviewed the literature on this subject using PubMed and Google Scholar, incorporating articles published from 1981–2026. This review highlights the landscape of interventions to treat and minimize long-term visual impairment from optic neuropathy in demyelinating diseases, considers relapse prevention to a lesser extent, and projects forward to the future in which neuroprotection becomes a reality.