The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists

Abstract

Objective To determine whether the Optic Neuritis Treatment Trial (ONTT) results have altered the practice patterns of ophthalmologists and neurologists. Design Mail survey. Participants A random sample of 987 ophthalmologists and 900 neurologists practicing in the United States were mailed a questionnaire that inquired into decision-making with regard to management of optic neuritis before and after the publication of the ONTT results. Main outcome measures Responses received from 202 ophthalmologists and 244 neurologists, a response rate of 47%. Results Following the ONTT reports, nearly all ophthalmologists and neurologists have reduced their use of oral prednisone alone, substituting a regimen that includes intravenous methylprednisolone. A large proportion of practitioners in both specialties mistakenly believe that intravenous methylprednisolone treatment improves final visual outcome. Only 7% of neurologists and 36% of ophthalmologists ( P = 0.0001) are adhering to the ONTT suggestion to use magnetic resonance imaging as a basis for initiating treatment. Conclusions The ONTT has led to a dramatic reduction in the use of oral prednisone without a preceding course of intravenous methylprednisolone in the treatment of acute optic neuritis. Ophthalmologists and neurologists have changed some of their practices without fully understanding the results of the ONTT.