Visual function at baseline and 1 month in acute optic neuritis: Predictors of visual outcome

Background:: While damage to the optic nerve following optic neuritis (ON) is readily quantifiable, the evaluation of prognosis for visual function and neuroaxonal loss in the acute ON is challenging. Objective:: The objective of this study is to investigate the value of multifocal visual evoked potential (mfVEP) in acute ON, diagnostically for acute ON and prognostically for visual outcome and subsequent ganglion cell/inner plexiform layer thickness (GCLIPLt). Methods:: A prospective cohort study of mfVEP and full-field visual evoked potential (ffVEP) in acute, unilateral ON (onset < 31 days) was conducted. Comparisons with healthy controls ( n = 30) and association analysis with follow-up optical coherence tomography (OCT) measurements (of the GCLIPLt) and visual function (Sloan low-contrast visual acuity (LCVA)) were conducted. Results:: Seventy-nine ON patients were included (mean: 17 days from onset). Excluding measurements with conduction block, ffVEP ( n = 54) and mfVEP ( n = 44) showed sensitivities of 89% and 84% to a specificity of 97%. 65/79 patients were re-examined (mean: 200 days follow-up). mfVEP amplitude and latency inter-eye asymmetry in acute ON correlated with GCLIPLt ( r = 0.587 and Spearman’s ρ = 0.597, for both, p < 0.001). mfVEP amplitude correlated with LCVA inter-eye asymmetry at follow-up ( r = 0.421, p < 0.001), mfVEP latency did not. Conclusion: mfVEP may support the prognostic evaluation of acute ON patients and prove valuable in future neuroprotective and remyelinating trials. In acute ON, the increase in diagnostic value of mfVEP to ffVEP may be limited due to widespread conduction block.

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Corticosteroids in the Treatment of Acute Optic Neuritis

50 Studies Every Ophthalmologist Should Know ◽

10.1093/med/9780190050726.003.0047 ◽

2020 ◽

pp. 285-290

Author(s):

Alan D. Penman ◽

Kimberly W. Crowder ◽

William M. Watkins

Keyword(s):

Clinical Trial ◽

Optic Neuritis ◽

Visual Loss ◽

Oral Prednisone ◽

Visual Outcome ◽

Controlled Clinical Trial ◽

Treatment Trial ◽

Intravenous Methylprednisolone ◽

Acute Optic Neuritis ◽

Optic Neuritis Treatment Trial

The Optic Neuritis Treatment Trial (ONTT) was a randomized, placebo-controlled, clinical trial in patients with a history consistent with acute unilateral optic neuritis to determine whether treatment with either oral prednisone or intravenous methylprednisolone speeded the recovery of vision and improve visual outcome. The study found that intravenous methylprednisolone (started within eight days of symptom onset) followed by oral prednisone speeded the recovery of visual loss due to optic neuritis and resulted in slightly better vision at six months. Oral prednisone alone, however, was an ineffective treatment and may increase the risk of new episodes of optic neuritis.

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Simvastatin improves final visual outcome in acute optic neuritis: a randomized study

Multiple Sclerosis Journal ◽

10.1177/1352458511415452 ◽

2011 ◽

Vol 18 (1) ◽

pp. 72-81 ◽

Cited By ~ 34

Author(s):

Anna Tsakiri ◽

Klaus Kallenbach ◽

Dan Fuglø ◽

Benedikte Wanscher ◽

Henrik Larsson ◽

...

Keyword(s):

Optic Neuritis ◽

Beneficial Effect ◽

Brain Mri ◽

Randomized Study ◽

Visual Outcome ◽

Small Scale ◽

Colour Perception ◽

Simvastatin Treatment ◽

Therapeutic Implications ◽

Acute Optic Neuritis

Background: In recent years, small-scale clinical trials have indicated that statins or 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase inhibitors exert pleiotropic immunomodulatory effects, with potential therapeutic implications in multiple sclerosis (MS). Objective: To investigate whether simvastatin treatment (80 mg daily for 6 months) in patients with optic neuritis (ON) had a beneficial effect on visual outcome and on brain MRI. Methods: Sixty-four patients with acute ON were randomized to simvastatin treatment ( n = 32) or placebo ( n = 32) for 6 months. None of the patients had been on immunosuppressive therapy for 6 months prior to inclusion or treated with steroids from symptom onset. Contrast sensitivity (Arden plates), visual acuity, colour perception, visual evoked potentials (VEP) – latency and amplitude, Visual Analogue Scale (VAS) score, and gadolinium enhancing and T2 lesions on brain MRI were evaluated at screening visit, day 14 (except brain MRI), day 90 and day 180. Results: Simvastatin had a beneficial effect on VEP in both latency ( p = 0.01) and amplitude ( p = 0.01), a borderline effect on the Arden score ( p = 0.06) and VAS ( p = 0.04), and no effect on brain MRI or on relapse rate between the groups. Conclusion: This study provides Class I evidence that simvastatin 80 mg daily is well tolerated and possibly effective in patients with acute ON.

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Phosphorylated Neurofilament Heavy Chain Correlations to Visual Function, Optical Coherence Tomography, and Treatment

Multiple Sclerosis International ◽

10.1155/2010/542691 ◽

2010 ◽

Vol 2010 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Joshua Pasol ◽

William Feuer ◽

Cui Yang ◽

Gerry Shaw ◽

Randy Kardon ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Optic Neuritis ◽

Heavy Chain ◽

Visual Function ◽

Oral Prednisone ◽

Study Entry ◽

Axonal Loss ◽

Optical Coherence ◽

Fiber Layer ◽

Acute Optic Neuritis

Objective. To correlate visual and neurologic clinical scores and treatment of optic neuritis and multiple sclerosis (MS) patients with assays of serum phosphorylated neurofilament heavy chain (pNF-H) and optical coherence tomography (OCT) measurements of axonal loss.Design/Methods. The Optic Neuritis Treatment Trial (ONTT) randomized 457 patients with acute optic neuritis to intravenous methylprednisolone (IVMP) followed by oral prednisone, oral prednisone or placebo treatment arms. We quantified serum pNF-H levels in 175 ONTT patients 5 years after study entry. We performed OCT measurements of macular volume and the retinal nerve fiber layer (RNFL) in a subset of 51 patients at year 15.Results. Elevated pNF-H levels at year 5 correlated to poorer visual function at study entry. Lower 15 year macular volumes and RNFL thickness correlated better with follow-up than with baseline visual function measures. With IVMP treatment, 15 year RNFL differences of the fellow eye (FE) minus the affected eye (SE) RNFLFEmSE correlated with five-year pNF-H levels. PNF-H was reduced by half with IVMP relative to placebo or by 40% relative to prednisone.Conclusions/Relevance. Acute optic neuritis patients who have more severe visual loss during initial presentation have a higher incidence of axonal loss that was slightly suppressed with IVMP treatment.

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A longitudinal conventional and magnetization transfer magnetic resonance imaging study of optic neuritis

Multiple Sclerosis Journal ◽

10.1177/1352458506071212 ◽

2007 ◽

Vol 13 (2) ◽

pp. 265-268 ◽

Cited By ~ 15

Author(s):

L Melzi ◽

Ma Rocca ◽

S Bianchi Marzoli ◽

A Falini ◽

P Vezzulli ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Optic Neuritis ◽

Magnetization Transfer ◽

Imaging Study ◽

Visual Outcome ◽

First Episode ◽

Resonance Imaging ◽

Acute Optic Neuritis ◽

Magnetic Resonance Imaging Mri

Eleven consecutive patients with a first episode of acute optic neuritis were evaluated, using conventional and magnetization transfer (MT) magnetic resonance imaging (MRI), in order to assess the temporal evolution of optic nerve (ON) damage and to investigate the correlation of ON damage with visual outcome and electrophysiological parameters. Patients underwent neuro-ophthalmological, neurological, electrophysiological, and MRI assessments at baseline and after three and 12 months. ON volumes were measured on coronal T1–weighted images using a local thresholding segmentation technique. MT ratio (MTR) from the ON was derived from gradient echo images. No significant volume difference was detected between affected and healthy ON, both at baseline and follow-up. At baseline, mean MTR values were significantly higher in affected ON than in healthy ON (P = 0.001), whereas at months 3 and 12, the mean MTR values were significantly reduced in the affected ON (P = 0.02 and 0.003, respectively). Mean MTR of the affected ON, corrected for healthy ON values, progressively decreased over time (P = 0.04 at month 3 and P = 0.0012 at month 12). On the contrary, MTR values of healthy ON remained stable. No correlations were found between MTR measures and clinical or electrophysiological data. This study shows the presence of subtle pathological changes, possibly due to residual demyelination and subsequent additional demyelination and impaired remyelination, in the ON of patients with a first episode of optic neuritis. In the early phase of optic neuritis, MT MRI is more sensitive than atrophy measurements in detecting disease-related changes. Multiple Sclerosis 2007; 13: 265–268. http://msj.sagepub.com

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