Clinical Characteristics, Treatment Outcomes and Predictive Factors in Optic Neuritis.

Linda Hansapinyo,Chayanee Vivattanaseth

doi:10.2174/1874364101812010247

Abstract

Background:The causes, clinical presentations and treatment outcomes of optic neuritis are distinct among different populations. Early diagnosis based on clinical presentations plays an important role in treating optic neuritis patients.Objective: The study aimed to determine clinical characteristics, treatment outcomes and predictive factors of treatment outcomes in optic neuritis patients with and without demyelinating disease.Methods:A retrospective descriptive study of optic neuritis patients carried out between January 2009 and December 2016 was done. Univariate analysis and multivariate logistic regression analysis were used to evaluate the predictive factors of treatment outcomes.Results:Among 150 patients with optic neuritis, 58 patients were diagnosed with Neuromyelitis Optica Spectrum Disease (NMOSD), 23 patients were diagnosed with Multiple Sclerosis (MS) and 69 patients were idiopathic. The age at presentation in the NMOSD group was significantly younger than the MS group and the idiopathic group. The female:male ratio was significantly lower in the idiopathic group than in the NMOSD group. The initial Best Corrected Visual Activity (BCVA) of 20/20-20/60 (p = 0.001) and the idiopathic group (p =0.030) was associated with good visual outcomes. Initial BCVA of < 20/200 (p = 0.009) and the NMOSD group (p < 0.001) was associated with poor visual outcomes.Conclusion:NMOSD is a more common cause of optic neuritis than MS in Thai population. Female patients with poor initial VA, poor response to steroids treatment, and presenting recurrent attacks are highly suspicious for NMOSD. Optic neuritis without associated demyelinating disease has a better visual outcome and lower recurrence rate.

Highlights

Optic neuritis is an inflammatory disease of the optic nerve that typically manifests as an acute visual loss and pain upon eye movements
We excluded 6 patients diagnosed with secondary causes of optic neuritis, such as syphilis, human immunodeficiency virus infection and vaccination
Among 150 patients with optic neuritis, 58 (38.7%) patients were diagnosed with Neuromyelitis Optica Spectrum Disease (NMOSD), 23 (15.3%) patients were diagnosed with Multiple Sclerosis (MS) and 69 (46.0%) patients were idiopathic

Summary

Introduction

Optic neuritis is an inflammatory disease of the optic nerve that typically manifests as an acute visual loss and pain upon eye movements. Most of the typical form of optic neuritis occurs idiopathically or MS-related. Based on the Optic Neuritis Treatment Trial (ONTT), both idiopathic and MS-related have positive treatment results [5]. Etiologies of the atypical form of optic neuritis include NMOSD, autoimmune disease, and infection. Many studies have shown differences in gender distribution, a mean age of disease, clinical presentations and post-treatment visual outcomes between Asian and Western population. Only a few studies compared clinical characteristics and treatment results in a different type of optic neuritis in Asians. We aim to establish clinical characteristics and treatment outcomes in optic neuritis with and without demyelinating disease (NMOSD, MS), and identify predictive factors of treatment outcomes in Thai population. The causes, clinical presentations and treatment outcomes of optic neuritis are distinct among different populations. Diagnosis based on clinical presentations plays an important role in treating optic neuritis patients

Methods

Results

Discussion

Conclusion