Most pediatric optic neuritis patients recover normal vision

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

The authors reviewed the charts of 59 pediatric patients with first-episode optic neuritis seen at a tertiary care hospital over a 10-year period. Their mean age was 12.6 years. Seventy-two percent were female, and 41% had bilateral involvement. Fifty-two percent had or developed an underlying diagnosis (39% multiple sclerosis, 7% acute disseminated encephalomyelitis, 7% neuromyelitis optica). Ninety-one percent received treatment (85% steroids, 7% multimodal).

At one year, 81% had at least 20/20 vision and 89% at least 20/40. Vision < 20/20 at three months was 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 diagnoses were not significantly associated with poor visual outcomes.

They write that given the lack of evidenced-based data for the treatment of pediatric optic neuritis, it would be ideal to conduct a prospective clinical trial to look at the efficacy of immunotherapy compared to placebo. However, survey data indicate that parents are reluctant to enroll their children in randomized trials, and many centers now consider systemic corticosteroids to be the standard of care. Therefore, a retrospective study including a larger group of untreated children and a prospective study comparing systemic corticosteroids to multimodal therapy might be more feasible options.