Can Optic Neuritis Be Diagnosed After the Acute Stage?

Here is My Question:
Can Optic Neuritis Be Diagnosed After the Acute Stage?

About a year ago, before MS was even on my radar, I experienced blurry vision in my left eye that I noticed one night out of the blue. Over a few days, the blurriness got worse until I could only see detail about 3-5 feet in front of me out of that eye. Before this, my vision in both eyes was 20/10 so a decrease in vision was really, really noticeable! Due to insurance reasons, I never went to a doctor or an ophthalmologist. It eventually got better about 10 weeks later and I no longer worried about it.
 
I had another episode in the same eye 2 1/2 months later but it wasn’t as bad as the first time and it followed an almost identical course as the time before. I did go to the doctor and ophthalmologist the last time and my vision in that eye was 20/30 and 6 months later 20/20. No bleeding, tumors, increased pressure, etc. The exam was fine. 

I had an OCT Scan done a year after the initial event and I have optic nerve thinning in both eyes: RNFL is 92 OD and 82 OS with my superior quadrant being in the 0% OU, the inferior quadrant being in the 5% and a 30 point difference in the nasal quadrant OS. My ophthalmologist did not know what to make of the findings so he just said we’ll check again in a year. He also didn’t seem to know that retrobulbar neuritis existed so I’m not putting much stock in his opinion anyway. 

My vision is much better but at the end of a long day, or if I get overheated, the vision in my left eye blurs a bit and everything looks much darker as if I’m looking through two different lenses. 
Based on this information, could a more experienced neuro ophthalmologist tell if it was ON a year ago? 

Also, does ON always cause pallor of the optic nerve? I was told my nerve had no pallor but once again, I’m not so sure I trust my ophthalmologist. 

Answer:
Yes you can have optic neuritis diagnosed by an experienced neuro ophthalmologist.
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It is always easier to diagnosis it when the acute vision loss occurs but if the neuro ophthalmologist is able to obtain a complete history and exam and review your OCT findings (and perhaps an MRI of the brain), he/she should be able to make the diagnosis if you have had optic neuritis.

Benjamin Osborne, MD
Associate Professor of Neurology and Ophthalmology
Director, Neuromyelitis Optica (NMO) Clinic
Director, Neuro-Ophthalmology Clinic
Associate Director of the NIH/Georgetown Neurology Residency Program
Medstar Georgetown University Hospital
3800 Reservoir Road, NW 7PHC
Washington, DC 20007