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  • Pediatric Optic Neuritis: Two-Year Outcomes

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, August 2022

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    Pediatric optic neuritis (ON) is a rare condition that is poorly understood. In a prospective study of outcomes through two years, Pineles et al. evaluated VA, recurrence risk, and final diagnoses. They found that even though vision was poor at presentation, recov­ery was possible for most patients, but associated neurologic conditions were common.

    Twenty-three pediatric ophthalmol­ogy clinics in North America partici­pated in the study, and treatments were chosen by participating investigators. At enrollment, a study-certified examiner tested monocular distance high-con­trast VA (HCVA) and low-contrast VA (LCVA) in each patient’s habitual refractive correction state, using the electronic Amblyopia Treatment Study HOTV protocol for those under 7 years of age or the electronic ETDRS protocol for older children. Magnetic resonance imaging (MRI) of the brain, with and without intravenous gadolin­ium, was performed within two weeks of symptom onset.

    Initial and two-year MRI images were reviewed by the masked examiner (who was unaware of demographic or clinical data) to determine presence/absence of optic nerve enhancement or white matter lesions. Follow-up assess­ments occurred at months 1 and 6 and years 1 and 2.

    At each visit, the patients’ HCVA and LCVA were tested, and the anterior and posterior segments were examined. MRI-detected white matter lesions were considered to represent an associated neurologic autoimmune diagnosis. If a masked MRI reading or antibody finding for myelin oligodendrocyte glycoprotein (MOG)—or aquaporin-4, if tested—was discordant with the ini­tial diagnosis, study chairs reviewed all case data and adjudicated to a final diag­nosis. The main outcome measure was the proportion of eyes with age-normal HCVA; secondary outcomes included LCVA, neuroimaging findings, and final diagnoses.

    Of the 44 enrollees (median age, 10.3 years), 28 (63.6%) completed the two-year assessment. Final diagnoses were isolated ON (39%), MOG-asso­ciated demyelination (29%), multiple sclerosis (14%), neuromyelitis optica spectrum disorder (11%), and acute disseminated encephalomyelitis (7%). Five patients (18%) had ON recurrence during follow-up. Recurrence and neu­rologic conditions were less common with isolated ON. Mean VA improved from approximately 20/125 at presen­tation to approximately 20/25-2 by six months and was maintained through two years. Twenty-four children (79%) had age-normal VA at two years, and VA was 20/20 or better for 21 partic­ipants (66%). Mean LCVA improved from the presenting logMAR score of 1.45 to scores of .78 by six months and .68 by two years.

    These data provide insight on the risk of ON recurrence and associated neurologic autoimmune disorders, which can affect VA, said the authors. They recommend comparing treatment strategies to further optimize VA outcomes.

    The original article can be found here.