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  • Visual Outcomes of Children With Optic Neuritis

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, December 2020

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    Since optic neuritis (ON) is uncom­mon in children, little data exist on outcomes, related conditions, and neuroimaging hallmarks. Pineles et al. prospectively studied visual outcomes for children with ON to gain insight and improve counseling of families. Although the number of participants was shy of the group’s goal, improve­ment occurred in most of the children. Concomitant neurologic autoimmune diagnoses were common among partic­ipants in the study group.

    This pilot study took place from Sep­tember 2016 to July 2018 and included 23 centers in the United States and Canada that specialize in pediatric oph­thalmology or neuro-ophthalmology. Inclusion criteria were presentation of the first ON episode within two weeks of symptom onset and at least one of the following features in the affected eye: distance high-contrast visual acuity (HCVA) deficit of at least 0.2 logMAR below age-based norm, diminished color vision, abnormal visual field, or optic disc swelling. Children with any preexisting ocular abnormality were excluded. The main outcome measures were monocular HCVA and low-con­trast VA six months after onset of ON. Other outcomes were findings of neu­roimaging, associated diagnoses, and specific antibodies.

    Although the researchers hoped that 100 children would be enrolled during the two-year period, only 44 qualified for participation (age range, 3-15 years). Of these, 40 (91%) were treated with corticosteroids; the remainder received no medication during the study. ON was bilateral in 16 patients (36%). Magnetic resonance imaging showed white-matter lesions in 23 children (52%); eight of these patients had myelin oligodendrocyte glycoprotein–associated demyelination, seven had acute disseminated encephalomyelitis, five had multiple sclerosis, and three had neuromyelitis optica.

    Baseline HCVA was worse in young­er participants (<10 years of age), those with neurologic autoimmune conditions or white-matter lesions, and patients who were neither White nor Hispanic. The baseline mean HCVA of 0.95 logMAR (20/200) improved to 0.12 logMAR (20/25) by six months. The mean distance low-contrast VA of 1.49 logMAR (20/640) at baseline improved to 0.73 logMAR (20/100) by six months. There were no meaningful relationships between baseline factors and HCVA improvement.

    The rarity of ON in children may warrant different inclusion criteria and wider enrollment windows to attain adequate sample sizes for treatment tri­als, the authors noted. (Also see related commentary by Dan Milea, MD, PhD, in the same issue.)

    The original article can be found here.