Early Treatment May Be Needed for MS and NMOSD-Related Optic Neuritis

A 7-day delay in methylprednisolone administration in patients with optic neuritis due to neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), or double-seronegative optic neuritis (DN-ON) significantly decreases the odds of gaining visual recovery, according to a recently published study in Vision.

Optic neuritis can be caused by several diseases, including NMOSD, MS, and DN-ON. The clinical characteristics of optic neuritis can vary according to the underlying cause. The authors aimed to analyze these distinct clinical characteristics as well as the factors influencing visual recovery in each context.

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This retrospective study included 76 affected eyes from 61 patients with optic neuritis due to NMOSD, MS, or DN-ON treated at the Rajavithi Hospital in Bangkok, Thailand over a 9-year timespan. Over 50% of the included patients were diagnosed with DN-ON, and approximately 30% were diagnosed with NMOSD. Researchers used the logarithm of minimum angle of resolution (logMAR) to assess visual acuity at nadir and after 12 months.

“Stable and worse outcomes are defined when there is no change within the range of −0.3 to +0.3 logMAR, or a decrease of more than −0.3 logMAR at the 12-month follow-up period,” the authors wrote.

There was a female predominance in the 3 groups, which is consistent with findings from other reports. NMOSD was associated with the worst visual outcomes after 12 months. Patients with NMOSD had the worst visual acuity at baseline compared to patients from the other groups; no patients from the NMOSD group had a significant 0.3 logMAR improvement after 12 months.

A delay in administering corticosteroid treatment with methylprednisolone within the first 7 days after the onset of symptoms led to a 5-fold increase in poor outcomes after 12 months of follow-up.

“Neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) was the second most common cause of optic neuritis and also a predictor of worse visual outcome in our series, and the administration of intravenous methylprednisolone within 7 days may be essential for the attainment of at least 0.3 logMAR of visual recovery in Thai patients,” the authors concluded.

Reference

Kemchoknatee P, Singhakul C, Arjkongharn N, et al. A 10-year single-center study of the clinical characteristics of optic neuritis-related NMOSD, MS, and double seronegative optic neuritis, together with factors predicting visual outcomes. Vision. Published online February 28, 2023. doi:10.3390/vision7010016