Development of a predictive model for predicting disability after optic neuritis: a secondary analysis of the Optic Neuritis Treatment Trial

Abstract

ObjectiveThe present study aimed to develop a prediction model for predicting developing debilities after optic neuritis.MethodsThe data for this research was obtained from the Optic Neuritis Treatment Trial (ONTT). The predictive model was built based on a Cox proportional hazards regression model. Model performance was assessed using Harrell’s C-index for discrimination, calibration plots for calibration, and stratification of patients into low-risk and high-risk groups for utility evaluation.ResultsA total of 416 patients participated. Among them, 101 patients (24.3%) experienced disability, which was defined as achieving or surpassing a score of 3 on the expanded disability status scale. The median follow-up duration was 15.5 years (interquartile range, 7.0 to 16.8). Two predictors in the final predictive model included the classification of multiple sclerosis at baseline and the condition of the optic disk in the affected eye at baseline. Upon incorporating these two factors into the model, the model’s C-index stood at 0.71 (95% CI, 0.66–0.76, with an optimism of 0.005) with a favorable alignment with the calibration curve. By utilizing this model, the ONTT cohort can be categorized into two risk categories, each having distinct rates of disability development within a 15-year timeframe (high-risk group, 41% [95% CI, 31–49%] and low-risk group, 13% [95% CI, 8.4–17%]; log-rank p-value of <0.001).ConclusionThis predictive model has the potential to assist physicians in identifying individuals at a heightened risk of experiencing disability following optic neuritis, enabling timely intervention and treatment.