Most children with optic neuritis had marked improvement in visual acuity by 6 months even though they had poor visual acuity at presentation, according to the results of a nonrandomized observational study called PON1, which was published in Opthalmology. This improvement was maintained over 2 years.
Pediatric optic neuritis is a rare disease, which is not well characterized. PON1 is the first prospective study that evaluated visual acuity, recurrence risk, and final diagnosis 2 years after enrollment.
The study took place in 23 pediatric ophthalmology or neuro-ophthalmology clinics in the US and Canada and enrolled 44 children, aged 3 to 16 years. Of these, 28 (64%) completed the 2-year study visit.
The primary outcome of the observational study was the age-normal monocular high contrast visual acuity. Secondary outcomes included low contrast visual acuity, neuroimaging findings, and final diagnosis. Of the 28 patients who completed the 2-year study visit, 19 (68%) had unilateral optic neuritis at presentation.
At the end of the 2 years, 11 patients were diagnosed with isolated optic neuritis, 8 with myelin oligodendrocyte glycoprotein-associated demyelination, 4 with multiple sclerosis (MS), 3 with neuromyelitis optica spectrum disorder (NMOSD), and 2 with acute disseminated encephalomyelitis.
Read more about NMOSD overview
Two of the participants had subsequent recurrent optic neuritis, and two other participants had optic neuritis in their other eyes. The mean age-normal monocular high contrast visual acuity of the participants continually improved. A total of 24 participants had normal age-normal monocular high contrast visual acuity at 2 years while 21 had 20/20 vision or better.
Participants who did not have age-normal visual acuity were diagnosed with NMOSD, MS, or isolated optic neuritis at 2 years. Participants presenting with low contrast visual acuity also improved steadily.
“Despite poor [visual acuity] at presentation, most children had marked improvement in [visual acuity] by 6 months which was maintained over two years,” the researchers concluded.
Pineles SL, Henderson RJ, Repka MX, et al. The pediatric optic neuritis prospective outcomes study – two-year results. Ophthalmology. 2022;29:S0161-6420. doi:10.1016/j.ophtha.2022.03.021