Children with optic neuritis (ON) often experience a marked improvement in visual acuity (VA) after 6 months which they are able to maintain for 2 years, despite presenting with poor VA, according to a study published in Ophthalmology. Secondary findings also revealed that autoimmune conditions were common in these patients.     

Researchers included 32 eyes of 28 patients (median age 10.3 years, 46% girls, 68% unilateral cases) in the multicenter observational analysis. Inclusion criteria included a diagnosis of ON with accompanying vision loss or pain upon eye movements for a period of 2 weeks or less. Additionally, participants needed to experience a 0.2 logMAR  deficit or greater in distance high contrast visual acuity (HCVA) below normative values for their age group, optic disk swelling, visual field abnormalities, or reduced color vision. The team measured HCVA and low contrast visual acuity (LCVA) in all patients and performed cycloplegic refractions.  

The researchers found that associated neurological autoimmune conditions occurred in 61% of the participants. The final 2-year diagnosis consisted of isolated ON (n=11, 40%), myelin oligodendrocyte glycoprotein (MOG)-associated demyelination (n=8, 29%), multiple sclerosis (MS) (n=4, 14%), neuromyelitis optica spectrum disease (NMOSD) (n=3, 11%), and acute disseminated encephalomyelitis (n=2, 7%). 


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In total, 2 participants (7%; 95% CI, 1-24%) experienced subsequent recurrent ON, and both had MS. Additionally, another 2 participants (7%) experienced a new episode in their previously unaffected eye. 

At 2-year completion, 24 participants (79%) had age-normal VA (95% CI, 60-90%) and 21 (66%) had 20/20 vision or better. Mean baseline LCVA improved from 1.45 to 0.68 logMAR at the 2-year study conclusion (95% CI, 0.48-0.88).  

“Despite poor VA at presentation, most children had marked improvement in VA by 6 months which was maintained over two years,” the researchers report. “The data suggest that a clinical diagnosis of isolated ON at the time of onset may reduce the risk of recurrence and the development of an associated neurologic condition.”

Study limitations include a high dropout rate and small sample size. 

Reference

Pineles SL, Henderson RJ, Repka MX, et al. The Pediatric Optic Neuritis Prospective Outcomes Study – two-year results. Ophthalmol. Published online March 29, 2022. doi:10.1016/j.ophtha.2022.03.021