Interconnected eye chart, MRI scan, and question marks symbolizing the complexity of ONSM diagnosis.

Decoding Diagnostic Errors: How to Protect Your Vision from Optic Nerve Sheath Meningiomas

Lena Voss in Health & Wellness November 2025 • 4 min read.

"A Deep Dive into Misdiagnosis, Prevention, and the Latest Strategies for Early Detection"

Optic nerve sheath meningiomas (ONSMs) are rare tumors that affect the optic nerve, potentially leading to significant vision loss if not diagnosed and treated promptly. These tumors, while typically benign, can compress the optic nerve, disrupting visual pathways and causing progressive vision impairment. The challenge lies in their diagnosis, as initial symptoms can often mimic other, more common conditions.

A recent study published in JAMA Neurology sheds light on the critical factors contributing to the misdiagnosis of ONSMs, emphasizing the importance of early and accurate detection. The research highlights how diagnostic errors can lead to delayed treatment, resulting in worse visual outcomes and increased healthcare costs. By understanding the common pitfalls in diagnosing ONSMs, individuals and healthcare providers can take proactive steps to safeguard vision.

This article explores the key findings of the JAMA Neurology study, providing insights into the common diagnostic errors associated with ONSMs. We will discuss the factors that contribute to misdiagnosis, the impact of delayed treatment, and the strategies for improving diagnostic accuracy, empowering you to take control of your eye health.

Unveiling the Causes: Why ONSM Misdiagnosis Happens

Interconnected eye chart, MRI scan, and question marks symbolizing the complexity of ONSM diagnosis.

The JAMA Neurology study retrospectively reviewed 35 patients with unilateral ONSM to identify the root causes of diagnostic errors. The study revealed that a significant number of patients experienced delays in diagnosis, with an average delay of 62.6 months. This delay was primarily attributed to two main categories of errors:

Clinician assessment failures: Errors in hypothesis generation and weighing. This means that doctors sometimes fail to consider ONSM as a possible diagnosis or don't give it enough weight compared to other conditions.
Errors in diagnostic testing: Problems with ordering, performing, or interpreting the results of diagnostic tests, such as MRI.

Generate an image, Surreal digital illustration, Eye exam chart, MRI scan of brain, question marks, all interconnected, suggesting complexity of medical diagnosis.

These errors often lead to initial misdiagnoses such as optic neuritis. The study also found that some patients underwent unnecessary procedures, such as lumbar punctures, and received inappropriate treatments, such as steroids, further highlighting the consequences of diagnostic errors.

Empowering Early Detection: Steps You Can Take

Early and accurate diagnosis of ONSM is crucial for preserving vision. If you experience any new or worsening visual symptoms, especially painless, progressive vision loss in one eye, seek prompt evaluation by a qualified neuro-ophthalmologist. Don't hesitate to advocate for appropriate neuroimaging, including MRI of the brain and orbits with contrast, to rule out compressive lesions like ONSM. By being proactive and informed, you can play an active role in protecting your vision.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1001/jamaneurol.2018.3989, Alternate LINK

Title: Diagnostic Errors In Initial Misdiagnosis Of Optic Nerve Sheath Meningiomas

Subject: Neurology (clinical)

Journal: JAMA Neurology

Publisher: American Medical Association (AMA)

Authors: Pinar Kahraman-Koytak, Beau B. Bruce, Jason H. Peragallo, Nancy J. Newman, Valérie Biousse

Published: 2019-03-01

Everything You Need To Know

What are Optic Nerve Sheath Meningiomas (ONSMs), and why are they difficult to diagnose?

Optic Nerve Sheath Meningiomas, or ONSMs, are rare tumors affecting the optic nerve, potentially causing vision loss. While usually benign, they can compress the optic nerve, disrupting visual pathways and leading to progressive vision impairment. Early symptoms often mimic other conditions, making accurate diagnosis challenging.

What were the primary reasons for misdiagnosis of Optic Nerve Sheath Meningiomas (ONSMs) identified in the JAMA Neurology study?

The *JAMA Neurology* study identified two main categories of diagnostic errors that lead to misdiagnosis of ONSMs: clinician assessment failures, involving errors in considering ONSM as a possible diagnosis, and errors in diagnostic testing, including issues with ordering, performing, or interpreting MRI results. These errors often result in initial misdiagnoses like optic neuritis.

What are the potential consequences of delays in diagnosing Optic Nerve Sheath Meningiomas (ONSMs)?

Delays in diagnosing Optic Nerve Sheath Meningiomas, as highlighted by the *JAMA Neurology* study, can lead to worse visual outcomes and increased healthcare costs. Furthermore, patients may undergo unnecessary procedures, such as lumbar punctures, and receive inappropriate treatments, such as steroids, which underscores the importance of timely and accurate diagnosis.

What steps can individuals take to ensure early detection of Optic Nerve Sheath Meningiomas (ONSMs) and protect their vision?

If you experience new or worsening visual symptoms, especially painless, progressive vision loss in one eye, it is crucial to seek prompt evaluation by a qualified neuro-ophthalmologist. Advocate for appropriate neuroimaging, including MRI of the brain and orbits with contrast, to rule out compressive lesions like Optic Nerve Sheath Meningiomas. Early detection is crucial for preserving vision.

According to the JAMA Neurology study, how long was the average delay in diagnosing Optic Nerve Sheath Meningiomas (ONSMs), and what contributed to this delay?

According to the *JAMA Neurology* study, the average delay in diagnosing Optic Nerve Sheath Meningiomas was 62.6 months. This significant delay underscores the challenges in diagnosing these tumors and highlights the importance of improving diagnostic accuracy to prevent delays in treatment and preserve vision. The delay was primarily attributed to clinician assessment failures and errors in diagnostic testing.