Optic neuritis: Prognosis and treatment
- Benjamin Osborne, MD
Benjamin Osborne, MD
- Assistant Professor
- Georgetown University Hospital
- Laura J Balcer, MD, MSCE
Laura J Balcer, MD, MSCE
- Professor of Neurology, Population Health and Ophthalmology
- Vice Chair, Department of Neurology
- NYU Langone Medical Center
- Section Editors
- Francisco Gonzalez-Scarano, MD
Francisco Gonzalez-Scarano, MD
- Section Editor — Multiple Sclerosis; Neurovirology & NeuroAIDS
- John P. Howe, III, MD, Distinguished Chair in Health Policy
- The University of Texas Health Science Center at San Antonio
- Paul W Brazis, MD
Paul W Brazis, MD
- Section Editor — Neuroophthalmology
- Professor of Neurology, Department of Ophthalmology
- Mayo Clinic College of Medicine
Optic neuritis is an inflammatory, demyelinating condition that causes acute, usually monocular, visual loss. It is highly associated with multiple sclerosis (MS), occurring in 50 percent of individuals at some time during the course of their illness [1-4]. Optic neuritis is the presenting feature of MS in 15 to 20 percent of patients.
The prognosis and treatment of demyelinating optic neuritis will be reviewed in this topic. The epidemiology, pathophysiology, clinical features, and diagnosis of optic neuritis are discussed separately. (See "Optic neuritis: Pathophysiology, clinical features, and diagnosis".)
The term optic neuritis is sometimes applied to other inflammatory and infectious conditions affecting the optic nerve. These and other causes of optic neuropathy and the management of multiple sclerosis are discussed separately. (See "Optic neuropathies" and "Treatment of progressive multiple sclerosis in adults" and "Disease-modifying treatment of relapsing-remitting multiple sclerosis in adults" and "Clinically isolated syndromes suggestive of multiple sclerosis" and "Diagnosis of multiple sclerosis in adults", section on 'Neuromyelitis optica'.)
Prognostic concerns in patients with optic neuritis are visual recovery, recurrence of optic neuritis, and risk of multiple sclerosis (MS).
Recovery of vision — Without treatment, vision begins to improve after a few weeks . Improvement can continue over many months; 90 percent have 20/40 or better vision at one year. Some patients may have a more or less favorable prognosis:
- Balcer LJ. Clinical practice. Optic neuritis. N Engl J Med 2006; 354:1273.
- Foroozan R, Buono LM, Savino PJ, Sergott RC. Acute demyelinating optic neuritis. Curr Opin Ophthalmol 2002; 13:375.
- Frohman EM, Frohman TC, Zee DS, et al. The neuro-ophthalmology of multiple sclerosis. Lancet Neurol 2005; 4:111.
- Arnold AC. Evolving management of optic neuritis and multiple sclerosis. Am J Ophthalmol 2005; 139:1101.
- The clinical profile of optic neuritis. Experience of the Optic Neuritis Treatment Trial. Optic Neuritis Study Group. Arch Ophthalmol 1991; 109:1673.
- Celesia GG, Kaufman DI, Brigell M, et al. Optic neuritis: a prospective study. Neurology 1990; 40:919.
- Beck RW, Gal RL, Bhatti MT, et al. Visual function more than 10 years after optic neuritis: experience of the optic neuritis treatment trial. Am J Ophthalmol 2004; 137:77.
- Visual function 5 years after optic neuritis: experience of the Optic Neuritis Treatment Trial. The Optic Neuritis Study Group. Arch Ophthalmol 1997; 115:1545.
- Kupersmith MJ, Gal RL, Beck RW, et al. Visual function at baseline and 1 month in acute optic neuritis: predictors of visual outcome. Neurology 2007; 69:508.
- Rizzo JF 3rd, Andreoli CM, Rabinov JD. Use of magnetic resonance imaging to differentiate optic neuritis and nonarteritic anterior ischemic optic neuropathy. Ophthalmology 2002; 109:1679.
- Hickman SJ, Toosy AT, Miszkiel KA, et al. Visual recovery following acute optic neuritis--a clinical, electrophysiological and magnetic resonance imaging study. J Neurol 2004; 251:996.
- Naismith RT, Xu J, Tutlam NT, et al. Disability in optic neuritis correlates with diffusion tensor-derived directional diffusivities. Neurology 2009; 72:589.
- Naismith RT, Xu J, Tutlam NT, et al. Radial diffusivity in remote optic neuritis discriminates visual outcomes. Neurology 2010; 74:1702.
- Naismith RT, Xu J, Tutlam NT, et al. Diffusion tensor imaging in acute optic neuropathies: predictor of clinical outcomes. Arch Neurol 2012; 69:65.
- Phillips PH, Newman NJ, Lynn MJ. Optic neuritis in African Americans. Arch Neurol 1998; 55:186.
- Kimbrough DJ, Sotirchos ES, Wilson JA, et al. Retinal damage and vision loss in African American multiple sclerosis patients. Ann Neurol 2015; 77:228.
- Moss HE, Gao W, Balcer LJ, Joslin CE. Association of race/ethnicity with visual outcomes following acute optic neuritis: an analysis of the Optic Neuritis Treatment Trial. JAMA Ophthalmol 2014; 132:421.
- Pokroy R, Modi G, Saffer D. Optic neuritis in an urban black African community. Eye (Lond) 2001; 15:469.
- Brady KM, Brar AS, Lee AG, et al. Optic neuritis in children: clinical features and visual outcome. J AAPOS 1999; 3:98.
- Kriss A, Francis DA, Cuendet F, et al. Recovery after optic neuritis in childhood. J Neurol Neurosurg Psychiatry 1988; 51:1253.
- KENNEDY C, CARROLL FD. Optic neuritis in children. Arch Ophthalmol 1960; 63:747.
- Lucchinetti CF, Kiers L, O'Duffy A, et al. Risk factors for developing multiple sclerosis after childhood optic neuritis. Neurology 1997; 49:1413.
- Riikonen R, Donner M, Erkkilä H. Optic neuritis in children and its relationship to multiple sclerosis: a clinical study of 21 children. Dev Med Child Neurol 1988; 30:349.
- Absoud M, Cummins C, Desai N, et al. Childhood optic neuritis clinical features and outcome. Arch Dis Child 2011; 96:860.
- Optic Neuritis Study Group. Visual function 15 years after optic neuritis: a final follow-up report from the Optic Neuritis Treatment Trial. Ophthalmology 2008; 115:1079.
- Martinez-Hernandez E, Sepulveda M, Rostásy K, et al. Antibodies to aquaporin 4, myelin-oligodendrocyte glycoprotein, and the glycine receptor α1 subunit in patients with isolated optic neuritis. JAMA Neurol 2015; 72:187.
- Raz N, Dotan S, Benoliel T, et al. Sustained motion perception deficit following optic neuritis: Behavioral and cortical evidence. Neurology 2011; 76:2103.
- Beck RW, Trobe JD, Moke PS, et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol 2003; 121:944.
- Nilsson P, Larsson EM, Maly-Sundgren P, et al. Predicting the outcome of optic neuritis: evaluation of risk factors after 30 years of follow-up. J Neurol 2005; 252:396.
- Matiello M, Lennon VA, Jacob A, et al. NMO-IgG predicts the outcome of recurrent optic neuritis. Neurology 2008; 70:2197.
- Banwell B, Tenembaum S, Lennon VA, et al. Neuromyelitis optica-IgG in childhood inflammatory demyelinating CNS disorders. Neurology 2008; 70:344.
- Takagi M, Tanaka K, Suzuki T, et al. Anti-aquaporin-4 antibody-positive optic neuritis. Acta Ophthalmol 2009; 87:562.
- Optic Neuritis Study Group. The 5-year risk of MS after optic neuritis. Experience of the optic neuritis treatment trial. Neurology 1997; 49:1404.
- Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch Neurol 2008; 65:727.
- Rodriguez M, Siva A, Cross SA, et al. Optic neuritis: a population-based study in Olmsted County, Minnesota. Neurology 1995; 45:244.
- Swanton JK, Fernando KT, Dalton CM, et al. Early MRI in optic neuritis: the risk for disability. Neurology 2009; 72:542.
- Wilejto M, Shroff M, Buncic JR, et al. The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology 2006; 67:258.
- Jin YP, de Pedro-Cuesta J, Huang YH, Söderström M. Predicting multiple sclerosis at optic neuritis onset. Mult Scler 2003; 9:135.
- Hely MA, McManis PG, Doran TJ, et al. Acute optic neuritis: a prospective study of risk factors for multiple sclerosis. J Neurol Neurosurg Psychiatry 1986; 49:1125.
- Rizzo JF 3rd, Lessell S. Risk of developing multiple sclerosis after uncomplicated optic neuritis: a long-term prospective study. Neurology 1988; 38:185.
- Corona-Vazquez T, Ruiz-Sandoval J, Arriada-Mendicoa N. Optic neuritis progressing to multiple sclerosis. Acta Neurol Scand 1997; 95:85.
- Alvarez G, Cárdenas M. Multiple sclerosis following optic neuritis in Chile. J Neurol Neurosurg Psychiatry 1989; 52:115.
- Lana-Peixoto MA, Lana-Peixoto MI. The risk of multiple sclerosis developing in patients with isolated idiopathic optic neuritis in Brazil. Arq Neuropsiquiatr 1991; 49:377.
- Wang JC, Tow S, Aung T, et al. The presentation, aetiology, management and outcome of optic neuritis in an Asian population. Clin Experiment Ophthalmol 2001; 29:312.
- Wakakura M, Minei-Higa R, Oono S, et al. Baseline features of idiopathic optic neuritis as determined by a multicenter treatment trial in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG). Jpn J Ophthalmol 1999; 43:127.
- Jacobs LD, Kaba SE, Miller CM, et al. Correlation of clinical, magnetic resonance imaging, and cerebrospinal fluid findings in optic neuritis. Ann Neurol 1997; 41:392.
- Alper G, Wang L. Demyelinating optic neuritis in children. J Child Neurol 2009; 24:45.
- Pirko I, Blauwet LA, Lesnick TG, Weinshenker BG. The natural history of recurrent optic neuritis. Arch Neurol 2004; 61:1401.
- Rolak LA, Beck RW, Paty DW, et al. Cerebrospinal fluid in acute optic neuritis: experience of the optic neuritis treatment trial. Neurology 1996; 46:368.
- Cole SR, Beck RW, Moke PS, et al. The predictive value of CSF oligoclonal banding for MS 5 years after optic neuritis. Optic Neuritis Study Group. Neurology 1998; 51:885.
- Söderström M, Ya-Ping J, Hillert J, Link H. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology 1998; 50:708.
- Frederiksen JL, Madsen HO, Ryder LP, et al. HLA typing in acute optic neuritis. Relation to multiple sclerosis and magnetic resonance imaging findings. Arch Neurol 1997; 54:76.
- Frederiksen JL, Larsson HB, Olesen J. Correlation of magnetic resonance imaging and CSF findings in patients with acute monosymptomatic optic neuritis. Acta Neurol Scand 1992; 86:317.
- Berger T, Rubner P, Schautzer F, et al. Antimyelin antibodies as a predictor of clinically definite multiple sclerosis after a first demyelinating event. N Engl J Med 2003; 349:139.
- Francis DA, Compston DA, Batchelor JR, McDonald WI. A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up. J Neurol Neurosurg Psychiatry 1987; 50:758.
- Kheradvar A, Tabassi AR, Nikbin B, et al. Influence of HLA on progression of optic neuritis to multiple sclerosis: results of a four-year follow-up study. Mult Scler 2004; 10:526.
- Lim ET, Berger T, Reindl M, et al. Anti-myelin antibodies do not allow earlier diagnosis of multiple sclerosis. Mult Scler 2005; 11:492.
- Beck RW, Cleary PA, Anderson MM Jr, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med 1992; 326:581.
- Gal RL, Vedula SS, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev 2012; 4:CD001430.
- Sellebjerg F, Nielsen HS, Frederiksen JL, Olesen J. A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis. Neurology 1999; 52:1479.
- Vedula SS, Brodney-Folse S, Gal RL, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev 2007; :CD001430.
- Kaufman DI, Trobe JD, Eggenberger ER, Whitaker JN. Practice parameter: the role of corticosteroids in the management of acute monosymptomatic optic neuritis. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 54:2039.
- Noseworthy JH, O'Brien PC, Petterson TM, et al. A randomized trial of intravenous immunoglobulin in inflammatory demyelinating optic neuritis. Neurology 2001; 56:1514.
- Roed HG, Langkilde A, Sellebjerg F, et al. A double-blind, randomized trial of IV immunoglobulin treatment in acute optic neuritis. Neurology 2005; 64:804.
- Tselis A, Perumal J, Caon C, et al. Treatment of corticosteroid refractory optic neuritis in multiple sclerosis patients with intravenous immunoglobulin. Eur J Neurol 2008; 15:1163.
- Ruprecht K, Klinker E, Dintelmann T, et al. Plasma exchange for severe optic neuritis: treatment of 10 patients. Neurology 2004; 63:1081.
- CHAMPS Study Group. Interferon beta-1a for optic neuritis patients at high risk for multiple sclerosis. Am J Ophthalmol 2001; 132:463.
- Kinkel RP, Kollman C, O'Connor P, et al. IM interferon beta-1a delays definite multiple sclerosis 5 years after a first demyelinating event. Neurology 2006; 66:678.
- Comi G, Filippi M, Barkhof F, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 357:1576.
- Kappos L, Polman CH, Freedman MS, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology 2006; 67:1242.
- Comi G, Martinelli V, Rodegher M, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet 2009; 374:1503.
- Boomer JA, Siatkowski RM. Optic neuritis in adults and children. Semin Ophthalmol 2003; 18:174.
- Farris BK, Pickard DJ. Bilateral postinfectious optic neuritis and intravenous steroid therapy in children. Ophthalmology 1990; 97:339.
- Jayakody H, Bonthius DJ, Longmuir R, Joshi C. Pediatric optic neuritis: does a prolonged course of steroids reduce relapses? A preliminary study. Pediatr Neurol 2014; 51:721.
- Horton L, Conger A, Conger D, et al. Effect of 4-aminopyridine on vision in multiple sclerosis patients with optic neuropathy. Neurology 2013; 80:1862.
- Sühs KW, Hein K, Sättler MB, et al. A randomized, double-blind, phase 2 study of erythropoietin in optic neuritis. Ann Neurol 2012; 72:199.