Predicting outcome for visual acuity in optic neuritis associated with multiple sclerosis
Reviewed by Lauren Hepworth

The authors present a retrospective cohort study to evaluate key predictors of long-term high-contrast visual acuity following optic neuritis associated with multiple sclerosis. All patients coded as optic neuropathy and assessed by a neuro-ophthalmologist over a 10-year period were screened for inclusion. Adults presenting with one or more acute episodes of optic neuritis, either idiopathic or associated with multiple sclerosis with the first assessment within 30 days and follow-up between 6–18 months were included. Patients diagnosed with seronegative neuromyelitis optica spectrum disorder (NMOSD) were excluded from the analysis. The following data were extracted from medical records; demographics, high-dose glucocorticoid treatment, pain, optic disc oedema, viral prodrome and best-corrected high contrast visual acuity. A 20% data extraction accuracy check was conducted by another author. A total of 118 patients were included in the analysis from 4910 screened. The median age was 39 years old, 67% female and 83% non-Hispanic Caucasian. There was a mean of six days between onset and diagnosis. Visual acuity at baseline was a median of 6/15 improving to a median of 6/6 at follow-up between 6–18 months post-diagnosis. The baseline visual acuity was identified as a predictor of long-term high-contrast visual acuity, in line with findings from the Optic Neuritis Treatment Trial. Being female and pain on presentation were both associated with better visual acuity at follow-up. Treatment with high-dose glucocorticoids was not a significant predictor of visual acuity outcome. The authors acknowledge that the findings of this study are only applicable to idiopathic and multiple sclerosis associated optic neuritis with a visual acuity baseline better than counting fingers. They also acknowledge the following limitations: recurrences of optic neuritis were not included in the modelling and lack of ethnic diversity. This study has validated previous findings and therefore can be now used to share prognostic factors with patients

Predictors of long-term visual acuity in a modern cohort of patients with acute idiopathic and multiple sclerosis-associated optic neuritis.
Jarocki A, Benard-Seguin E, Gonzalez LA, et al.
JOURNAL OF NEURO-OPHTHALMOLOGY
2023;43:475–80.