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Visual Function 5 Years After Optic Neuritis: Experience of the Optic Neuritis Treatment Trial

Visual Function 5 Years After Optic Neuritis: Experience of the Optic Neuritis Treatment Trial Abstract Objective: To assess the 5-year visual course, including the incidence of recurrent optic neuritis, in 454 patients enrolled in the Optic Neuritis Treatment Trial. Methods: Five-year follow-up vision testing, which included measures of visual acuity, contrast sensitivity, visual field, and color vision, was completed for 397 (87%) of the 454 patients. Results: Visual function test results in the eyes that experienced optic neuritis at study enrollment (affected eyes) were normal or only slightly abnormal after 5 years in most patients; the results did not significantly differ by treatment group (P=.37 for visual acuity). The visual acuity in the affected eyes was 20/25 or better in 87%, 20/25 to 20/40 in 7%, 20/50 to 20/190 in 3%, and 20/200 or worse in 3%. The recurrence of optic neuritis in either eye occurred in 28% of the patients and was more frequent in patients with multiple sclerosis (P=.001) and in patients without multiple sclerosis who were in the prednisone treatment group (P=.004). Most eyes with a recurrence retained normal or almost normal visual function. Conclusions: Most patients retained good to excellent vision in the 5 years following an attack of optic neuritis, even if the optic neuritis recurred. Recurrences were more frequent in patients with multiple sclerosis and in those treated with oral prednisone alone. The completion of the 5-year follow-up by the Optic Neuritis Treatment Trial cohort has not altered our management recommendations based on the results we reported earlier. References 1. Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis . N Engl J Med . 1992;326:581-588.Crossref 2. Beck RW, Cleary PA, Backlund JC, and the Optic Neuritis Study Group. The course of visual recovery after optic neuritis: experience of the Optic Neuritis Treatment Trial . Ophthalmology . 1994;101:1771-1778.Crossref 3. Keltner JL, Johnson CA, Spurr JO, Beck RW, and the Optic Neuritis Study Group. Visual field profile of optic neuritis: one-year follow-up in the Optic Neuritis Treatment Trial . Arch Ophthalmol . 1994;112:946-953.Crossref 4. Cleary PA, Beck RW, Bourque LB, Backlund JC, Miskala PH, for the Optic Neuritis Study Group. Visual symptoms after optic neuritis: results from the Optic Neuritis Treatment Trial . J Neuroophthalmol . 1997;17:18-28.Crossref 5. Beck RW, Cleary PA, and the Optic Neuritis Study Group. Optic Neuritis Treatment Trial: one-year follow-up results . Arch Ophthalmol . 1993;111:773-775.Crossref 6. Beck RW, Cleary PA, and the Optic Neuritis Study Group. Recovery from severe visual loss in optic neuritis . Arch Ophthalmol . 1993;111:300.Crossref 7. Beck RW, Cleary PA, Trobe JD, et al. The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis . N Engl J Med . 1993;329:1764-1769.Crossref 8. The Optic Neuritis Study Group. The five-year risk of multiple sclerosis after optic neuritis: experience of the Optic Neuritis Treatment Trial . Neurology . 1997;49:1404-1413.Crossref 9. Cleary PA, Beck RW, Anderson MM, et al. Design, methods, and conduct of the Optic Neuritis Treatment Trial . Control Clin Trials . 1993;14:123-142.Crossref 10. The Optic Neuritis Study Group. The clinical profile of acute optic neuritis: experience of the Optic Neuritis Treatment Trial . Arch Ophthalmol . 1991;109:1673-1678.Crossref 11. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;50:163-170. 12. Beck RW, Trobe JD, for the Optic Neuritis Study Group. The Optic Neuritis Treatment Trial: putting the results in perspective . J Neuroophthalmol . 1995;15:131-135. 13. Perkin GD, Rose FC. Optic Neuritis and Its Differential Diagnosis . Oxford, England: Oxford Medical Publications: 1979. 14. Nikoskelainen E. Later course and prognosis of optic neuritis . Acta Ophthalmol (Copenh) . 1975;53:273-291.Crossref 15. Bradley WG, Whitty CWM. Acute optic neuritis: prognosis for development of multiple sclerosis . J Neurol Neurosurg Psychiatry . 1968;31:10-18.Crossref 16. Cohen M, Lessell S, Wolf P. A prospective study of the risk of developing multiple sclerosis in uncomplicated optic neuritis . Neurology . 1979;29:208-221.Crossref 17. Marshall D. Ocular manifestations of multiple sclerosis and relationship to retrobulbar neuritis . Trans Am Ophthalmol Soc . 1950;48:487-525. 18. Schlossman A, Phillips C. Optic neuritis in relation to demyelinating diseases . Am J Ophthalmol . 1954;37:487-494. 19. Lynn BH. Retrobulbar neuritis: a survey of the present condition of cases occurring over the last fifty-six years . Trans Ophthalmol Soc U K . 1959;79:701-716. 20. Hutchinson WM. Acute optic neuritis and the prognosis for multiple sclerosis . J Neurol Neurosurg Psychiatry . 1976;39:283-289.Crossref 21. Rodriguez M, Siva A, Cross SA, O'Brien PC, Kurland LT. Optic neuritis: a populationbased study in Olmsted County, Minnesota . Neurology . 1995;45:244-250.Crossref 22. Kupersmith MJ, Nelson JI, Seiple WH, Carr RE, Weiss PA. The 20/20 eye in multiple sclerosis . Neurology . 1983;33:1015-1020.Crossref 23. Kupersmith MJ, Seiple WH, Nelson JI, Carr RE. Contrast sensitivity loss in multiple sclerosis . Invest Ophthalmol Vis Sci . 1984;25:632-639. 24. Engell T, Trojaborg W, Raun NE. Subclinical optic neuropathy in multiple sclerosis: a neuro-ophthalmological investigation by means of visually evoked response, Farnworth-Munsell 100 hue test and Ishihara test and their diagnostic value . Acta Ophthalmol (Copenh) . 1987;65:735-740.Crossref 25. Ashworth B, Aspinall PA, Mitchell JD. Visual function in multiple sclerosis . Doc Ophthalmol . 1990;73:209-224.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Visual Function 5 Years After Optic Neuritis: Experience of the Optic Neuritis Treatment Trial

Archives of Ophthalmology , Volume 115 (12) – Dec 1, 1997

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100160715008
Publisher site
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Abstract

Abstract Objective: To assess the 5-year visual course, including the incidence of recurrent optic neuritis, in 454 patients enrolled in the Optic Neuritis Treatment Trial. Methods: Five-year follow-up vision testing, which included measures of visual acuity, contrast sensitivity, visual field, and color vision, was completed for 397 (87%) of the 454 patients. Results: Visual function test results in the eyes that experienced optic neuritis at study enrollment (affected eyes) were normal or only slightly abnormal after 5 years in most patients; the results did not significantly differ by treatment group (P=.37 for visual acuity). The visual acuity in the affected eyes was 20/25 or better in 87%, 20/25 to 20/40 in 7%, 20/50 to 20/190 in 3%, and 20/200 or worse in 3%. The recurrence of optic neuritis in either eye occurred in 28% of the patients and was more frequent in patients with multiple sclerosis (P=.001) and in patients without multiple sclerosis who were in the prednisone treatment group (P=.004). Most eyes with a recurrence retained normal or almost normal visual function. Conclusions: Most patients retained good to excellent vision in the 5 years following an attack of optic neuritis, even if the optic neuritis recurred. Recurrences were more frequent in patients with multiple sclerosis and in those treated with oral prednisone alone. The completion of the 5-year follow-up by the Optic Neuritis Treatment Trial cohort has not altered our management recommendations based on the results we reported earlier. References 1. Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis . N Engl J Med . 1992;326:581-588.Crossref 2. Beck RW, Cleary PA, Backlund JC, and the Optic Neuritis Study Group. The course of visual recovery after optic neuritis: experience of the Optic Neuritis Treatment Trial . Ophthalmology . 1994;101:1771-1778.Crossref 3. Keltner JL, Johnson CA, Spurr JO, Beck RW, and the Optic Neuritis Study Group. Visual field profile of optic neuritis: one-year follow-up in the Optic Neuritis Treatment Trial . Arch Ophthalmol . 1994;112:946-953.Crossref 4. Cleary PA, Beck RW, Bourque LB, Backlund JC, Miskala PH, for the Optic Neuritis Study Group. Visual symptoms after optic neuritis: results from the Optic Neuritis Treatment Trial . J Neuroophthalmol . 1997;17:18-28.Crossref 5. Beck RW, Cleary PA, and the Optic Neuritis Study Group. Optic Neuritis Treatment Trial: one-year follow-up results . Arch Ophthalmol . 1993;111:773-775.Crossref 6. Beck RW, Cleary PA, and the Optic Neuritis Study Group. Recovery from severe visual loss in optic neuritis . Arch Ophthalmol . 1993;111:300.Crossref 7. Beck RW, Cleary PA, Trobe JD, et al. The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis . N Engl J Med . 1993;329:1764-1769.Crossref 8. The Optic Neuritis Study Group. The five-year risk of multiple sclerosis after optic neuritis: experience of the Optic Neuritis Treatment Trial . Neurology . 1997;49:1404-1413.Crossref 9. Cleary PA, Beck RW, Anderson MM, et al. Design, methods, and conduct of the Optic Neuritis Treatment Trial . Control Clin Trials . 1993;14:123-142.Crossref 10. The Optic Neuritis Study Group. The clinical profile of acute optic neuritis: experience of the Optic Neuritis Treatment Trial . Arch Ophthalmol . 1991;109:1673-1678.Crossref 11. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;50:163-170. 12. Beck RW, Trobe JD, for the Optic Neuritis Study Group. The Optic Neuritis Treatment Trial: putting the results in perspective . J Neuroophthalmol . 1995;15:131-135. 13. Perkin GD, Rose FC. Optic Neuritis and Its Differential Diagnosis . Oxford, England: Oxford Medical Publications: 1979. 14. Nikoskelainen E. Later course and prognosis of optic neuritis . Acta Ophthalmol (Copenh) . 1975;53:273-291.Crossref 15. Bradley WG, Whitty CWM. Acute optic neuritis: prognosis for development of multiple sclerosis . J Neurol Neurosurg Psychiatry . 1968;31:10-18.Crossref 16. Cohen M, Lessell S, Wolf P. A prospective study of the risk of developing multiple sclerosis in uncomplicated optic neuritis . Neurology . 1979;29:208-221.Crossref 17. Marshall D. Ocular manifestations of multiple sclerosis and relationship to retrobulbar neuritis . Trans Am Ophthalmol Soc . 1950;48:487-525. 18. Schlossman A, Phillips C. Optic neuritis in relation to demyelinating diseases . Am J Ophthalmol . 1954;37:487-494. 19. Lynn BH. Retrobulbar neuritis: a survey of the present condition of cases occurring over the last fifty-six years . Trans Ophthalmol Soc U K . 1959;79:701-716. 20. Hutchinson WM. Acute optic neuritis and the prognosis for multiple sclerosis . J Neurol Neurosurg Psychiatry . 1976;39:283-289.Crossref 21. Rodriguez M, Siva A, Cross SA, O'Brien PC, Kurland LT. Optic neuritis: a populationbased study in Olmsted County, Minnesota . Neurology . 1995;45:244-250.Crossref 22. Kupersmith MJ, Nelson JI, Seiple WH, Carr RE, Weiss PA. The 20/20 eye in multiple sclerosis . Neurology . 1983;33:1015-1020.Crossref 23. Kupersmith MJ, Seiple WH, Nelson JI, Carr RE. Contrast sensitivity loss in multiple sclerosis . Invest Ophthalmol Vis Sci . 1984;25:632-639. 24. Engell T, Trojaborg W, Raun NE. Subclinical optic neuropathy in multiple sclerosis: a neuro-ophthalmological investigation by means of visually evoked response, Farnworth-Munsell 100 hue test and Ishihara test and their diagnostic value . Acta Ophthalmol (Copenh) . 1987;65:735-740.Crossref 25. Ashworth B, Aspinall PA, Mitchell JD. Visual function in multiple sclerosis . Doc Ophthalmol . 1990;73:209-224.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Dec 1, 1997

References