Time to steroid treatment in severe acute optic neuritis

Abstract

ObjectivesSteroid treatment can accelerate visual recovery in patients with optic neuritis (ON), but it is unknown whether the timing of the start of treatment influences the outcome. The main purpose of this observational study was to assess the effect of early onset steroid treatment of ON on visual prognosis and retinal morphology.MethodsForty‐nine patients with acute mild/moderate (n = 21) or severe (n = 28) ON, and an equal number of healthy controls were enrolled. Patients with severe ON either received early onset steroid treatment (initiated within 1 week of presentation with visual loss) (n = 9), late‐onset treatment (initiated after 1 week) (n = 13), or no treatment (n = 6). Visual function and retinal morphology was studied after 6 and 12 months.ResultsAll measures of visual function had improved after 6 months (p ≤ 0.03) in the three groups with severe ON. This was not the case for Rayleigh match setting range (SR) in the nontreated group (p = 0.24), or for SR (p = 0.08) and latency to P100 of visual evoked potential (p = 0.08) in the late‐onset treated group. After 12 months, further improvement occurred in the nontreated and late‐treated groups, but not in the early treated group. Macular retinal nerve fiber layer (mRNFL) and ganglion cell plus inner plexiform layer had decreased significantly (p ≤ 0.001) in all three groups with severe ON after 6 months. After 12 months, only mRNFL had further significantly decreased and only in the late‐onset treated group (p = 0.02).ConclusionThe beneficial effects of early onset steroid treatment of ON is limited to a few months whereas the long‐term prognosis is independent of the timing of treatment.

Prognostic Factors for Recovery of Vision in Canine Optic Neuritis of Unknown Etiology: 26 Dogs (2003–2018)

“…In people with ON, one study reported improved visual acuity in Thai patients with isolated ON treated within 8 days from onset (79). In another study, early treatment (within 7 days from onset) was associated with better short-term visual outcomes in people with severe acute ON, but long-term visual acuity was not influenced by the timing of treatment (102).…”

A Randomized Prospective Trial Comparing Repository Corticotropin Injection and Intravenous Methylprednisolone for Neuroprotection in Acute Optic Neuritis

“…Differences between RCI and IVMP may be evident for rarer causes of acute optic neuritis (e.g., aquaporin-4-IgG seropositive neuromyelitis optica spectrum disease or MOGAD) 20 or with more rapid treatment. 21 Although only a single MOGAD optic neuritis patient was enrolled in this study, the low number may have been the result of exclusion criteria (bilateral optic neuritis and severe disc edema or hemorrhage) and the limited availability of commercial MOG-IgG testing. Nevertheless, the data from our trial may be helpful in powering future studies aimed at the identification of therapeutic and neuroprotective agents while using a common signature syndrome for acute ON as a template from which to detect and monitor treatment effects.…”