Characteristics, visual outcomes of pediatric optic neuritis

This large retrospective study of pediatric patients with optic neuritis found that the majority regain normal visual acuity at one year regardless of baseline clinical characteristics.

The authors reviewed the clinical characteristics and visual outcomes of pediatric patients presenting to a tertiary care pediatric hospital with a first episode of optic neuritis.

Of the 59 patients, 46 had at least three months’ follow-up and 36 had at least one year of follow-up. Clinical characteristics included a preponderance of females (72%) and a high proportion of patients with bilateral involvement (42%) and optic nerve edema (67%). This pattern of clinical features is consistent with several retrospective observational studies on pediatric optic neuritis.

At one year, 81% of patients were at least 20/20 and 89% were at least 20/40. Vision of <20/20 at three months was the only factor significantly associated with a poor visual outcome (<20/40) at one year. Other clinical characteristics, including visual acuity at presentation, sex, bilateral involvement, optic nerve edema and underlying diagnosis, were not significantly associated with a poor visual outcome.

They note that patients who regained normal visual acuity took an average of 61 days to do so. However, time to recovery was dependent on presenting visual acuity. Patients who presented with vision of counting fingers or worse took a mean of 97 days to recover normal vision while patients who presented with vision better than counting fingers took a mean of 35 days.

They write that this information may be useful for counseling optic neuritis patients on prognosis and for considering whether or not to use additional immunotherapy in patients not following the expected trajectory of recovery.