Abstract
Optic neuritis is a disease of extreme importance from the point of view of neuro-ophthalmologists. As a disease entity, it includes a spectrum ranging from the typical demyelinating isolated optic neuritis to that associated with systemic diseases such as multiple sclerosis and neuromyelitis optica and other atypical forms. This chapter discusses the clinical manifestations of the disease—the signs, symptoms, and the pertinent examination findings; it also highlights the required investigations and the differential diagnoses. The initial management of acute optic neuritis is described and also details about the prognosis in terms of the risk of developing the major associated neurological diseases, i.e., multiple sclerosis and neuromyelitis optica is discussed in detail. The long-term management strategies are also explained.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992;326:581–8. https://doi.org/10.1056/NEJM199202273260901.
Miller NR, Subramanian PS, Patel VR. Optic neuritis. In: Walsh and Hoyt’s clinical neuro-ophthalmology: the essentials. Philadelphia: Wolters Kluwer; 2016. p. 130–44.
Waldman AT, Stull LB, Galetta SL, et al. Pediatric optic neuritis and risk of multiple sclerosis: meta-analysis of observational studies. J AAPOS. 2011;15:441–6. https://doi.org/10.1016/j.jaapos.2011.05.020.
Rodriguez M, Siva A, Cross SA, et al. Optic neuritis: a population-based study in Olmsted County, Minnesota. Neurology. 1995;45:244–50.
Lau PPK, Yau GSK, Lee JWY, et al. Optic neuritis in Hong Kong: a 1-year follow-up study. Int Ophthalmol. 2014;35(3):303–10. https://doi.org/10.1007/s10792-014-9945-5.
Saxena R, Phuljhele S, Menon V, et al. Clinical profile and short-term outcomes of optic neuritis patients in India. Indian J Ophthalmol. 2014;62:265–7. https://doi.org/10.4103/0301-4738.121131.
Messenger W, Hildebrandt L, Mackensen F, et al. Characterisation of uveitis in association with multiple sclerosis. Br J Ophthalmol. 2015;99:205–9. https://doi.org/10.1136/bjophthalmol-2014-305518.
Keltner JL, Johnson CA, Cello KE, et al. Visual field profile of optic neuritis: a final follow-up report from the optic neuritis treatment trial from baseline through 15 years. Arch Ophthalmol. 2010;128:330–7. https://doi.org/10.1001/archophthalmol.2010.16.
Nevalainen J, Krapp E, Paetzold J, et al. Visual field defects in acute optic neuritis--distribution of different types of defect pattern, assessed with threshold-related supraliminal perimetry, ensuring high spatial resolution. Graefes Arch Clin Exp Ophthalmol. 2008;246:599–607. https://doi.org/10.1007/s00417-007-0722-2.
Rizzo JF, Andreoli CM, Rabinov JD. Use of magnetic resonance imaging to differentiate optic neuritis and nonarteritic anterior ischemic optic neuropathy. Ophthalmology. 2002;109:1679–84.
Vaphiades MS. Disk edema and cranial MRI optic nerve enhancement: how long is too long? Surv Ophthalmol. 2001;46:56–8.
Beck RW, Trobe JD. What we have learned from the optic neuritis treatment trial. Ophthalmology. 1995;102:1504–8. https://doi.org/10.1016/S0161-6420(95)30839-1.
Mancuso JD, Mody RM, Olsen CH, et al. The long-term effect of Bacille Calmette-Guérin vaccination on tuberculin skin testing: a 55-year follow-up study. Chest. 2017;152(2):282–94. https://doi.org/10.1016/j.chest.2017.01.001.
Frohman EM, Shah A, Eggenberger E, et al. Corticosteroids for multiple sclerosis: I. Application for treating exacerbations. Neurotherapeutics. 2007;4:618–26. https://doi.org/10.1016/j.nurt.2007.07.008.
Optic Neuritis Study Group. Visual function 15 years after optic neuritis: a final follow-up report from the Optic Neuritis Treatment Trial. Ophthalmology. 2008;115:1079–1082.e5. https://doi.org/10.1016/j.ophtha.2007.08.004.
Filippi M, Rocca MA, Ciccarelli O, et al. MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol. 2016;15:292–303. https://doi.org/10.1016/S1474-4422(15)00393-2.
Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch Neurol. 2008;65:727–32. https://doi.org/10.1001/archneur.65.6.727.
Kawasaki A, Purvin VA. Idiopathic chiasmal neuritis: clinical features and prognosis. Arch Ophthalmol. 2009;127:76–81. https://doi.org/10.1001/archophthalmol.2008.516.
Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177–89.
Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004;364:2106–12. https://doi.org/10.1016/S0140-6736(04)17551-X.
Wingerchuk DM, Lennon VA, Lucchinetti CF, et al. The spectrum of neuromyelitis optica. Lancet Neurol. 2007;6:805–15. https://doi.org/10.1016/S1474-4422(07)70216-8.
Matiello M, Lennon VA, Jacob A, et al. NMO-IgG predicts the outcome of recurrent optic neuritis. Neurology. 2008;70:2197–200. https://doi.org/10.1212/01.wnl.0000303817.82134.da.
Balcer LJ, Galetta SL. OCT and NMO: are there methods to our madness? J Neuroophthalmol. 2013;33:209–12. https://doi.org/10.1097/WNO.0b013e3182a1e6aa.
Lange AP, Sadjadi R, Zhu F, et al. Spectral-domain optical coherence tomography of retinal nerve fiber layer thickness in NMO patients. J Neuroophthalmol. 2013;33:213–9. https://doi.org/10.1097/WNO.0b013e31829c510e.
Bennett J, de Seze J, Lana-Peixoto M, et al. Neuromyelitis optica and multiple sclerosis: seeing differences through optical coherence tomography. Mult Scler. 2015;21(6):678–88. https://doi.org/10.1177/1352458514567216.
Naismith RT, Tutlam NT, Xu J, et al. Optical coherence tomography differs in neuromyelitis optica compared with multiple sclerosis. Neurology. 2009;72:1077–82. https://doi.org/10.1212/01.wnl.0000345042.53843.d5.
Park K-A, Kim J, Oh SY. Analysis of spectral domain optical coherence tomography measurements in optic neuritis: differences in neuromyelitis optica, multiple sclerosis, isolated optic neuritis and normal healthy controls. Acta Ophthalmol. 2013;92(1):e57–65. https://doi.org/10.1111/aos.12215.
Fernandes DB, Raza AS, Nogueira RG, et al. Evaluation of inner retinal layers in patients with multiple sclerosis or neuromyelitis optica using optical coherence tomography. Ophthalmology. 2013;120(2):387–94. https://doi.org/10.1016/j.ophtha.2012.07.066.
Ratchford JN, Quigg ME, Conger A, et al. Optical coherence tomography helps differentiate neuromyelitis optica and MS optic neuropathies. Neurology. 2009;73:302–8. https://doi.org/10.1212/WNL.0b013e3181af78b8.
Naismith RT, Tutlam NT, Xu J, et al. Optical coherence tomography is less sensitive than visual evoked potentials in optic neuritis. Neurology. 2009;73:46–52. https://doi.org/10.1212/WNL.0b013e3181aaea32.
Khanna S, Sharma A, Huecker J, et al. Magnetic resonance imaging of optic neuritis in patients with neuromyelitis optica versus multiple sclerosis. J Neuroophthalmol. 2012;32:216–20. https://doi.org/10.1097/WNO.0b013e318254c62d.
Storoni M, Davagnanam I, Radon M, et al. Distinguishing optic neuritis in neuromyelitis optica spectrum disease from multiple sclerosis: a novel magnetic resonance imaging scoring system. J Neuroophthalmol. 2013;33:123–7. https://doi.org/10.1097/WNO.0b013e318283c3ed.
Fernandes DB, Ramos R de IP, Falcochio C, et al. Comparison of visual acuity and automated perimetry findings in patients with neuromyelitis optica or multiple sclerosis after single or multiple attacks of optic neuritis. J Neuroophthalmol. 2012;32:102–6. https://doi.org/10.1097/WNO.0b013e31823a9ebc.
Merle H, Olindo S, Jeannin S, et al. Visual field characteristics in neuromyelitis optica in absence of and after one episode of optic neuritis. Clin Ophthalmol. 2013;7:1145. https://doi.org/10.2147/OPTH.S43894.
Zhou H, Zhao S, Yin D, et al. Optic neuritis: a 5-year follow-up study of Chinese patients based on aquaporin-4 antibody status and ages. J Neurol. 2016;263:1382–9. https://doi.org/10.1007/s00415-016-8155-7.
Lin N, Liu Q, Wang X, et al. Role of AQP4 antibody serostatus and its prediction of visual outcome in neuromyelitis optica: a systematic review and meta-analysis. Protein Pept Lett. 2017;24:245–52. https://doi.org/10.2174/0929866524666170110150436.
Brody J, Hellmann MA, Marignier R, et al. Neuromyelitis optica spectrum disorder: disease course and long-term visual outcome. J Neuroophthalmol. 2016;36(4):356–62. https://doi.org/10.1097/WNO.0000000000000403.
Jacobs LD, Beck RW, Simon JH, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000;343:898–904. https://doi.org/10.1056/NEJM200009283431301.
CHAMPS Study Group. Interferon beta-1a for optic neuritis patients at high risk for multiple sclerosis. Am J Ophthalmol. 2001;132:463–71.
Kappos L, Polman CH, Freedman MS, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006;67:1242–9. https://doi.org/10.1212/01.wnl.0000237641.33768.8d.
Comi G, Martinelli V, Rodegher M, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet. 2009;374:1503–11. https://doi.org/10.1016/S0140-6736(09)61259-9.
Confavreux C, Vukusic S, Adeleine P. Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process. Brain J Neurol. 2003;126:770–82.
Deryck O, Ketelaer P, Dubois B. Clinical characteristics and long term prognosis in early onset multiple sclerosis. J Neurol. 2006;253:720–3. https://doi.org/10.1007/s00415-006-0095-1.
Baghizadeh S, Sahraian MA, Beladimoghadam N. Clinical and demographic factors affecting disease severity in patients with multiple sclerosis. Iran J Neurol. 2013;12:1–8.
Goodin DS, Bates D. Review: treatment of early multiple sclerosis: the value of treatment initiation after a first clinical episode. Mult Scler. 2009;15:1175–82. https://doi.org/10.1177/1352458509107007.
Iaffaldano P, Viterbo RG, Trojano M. Natalizumab discontinuation is associated with a rebound of cognitive impairment in multiple sclerosis patients. J Neurol. 2016;263(8):1620–5. https://doi.org/10.1007/s00415-016-8177-1.
Simao LM. Ophthalmologic manifestations commonly misdiagnosed as demyelinating events in multiple sclerosis patients. Curr Opin Ophthalmol. 2010;21:436–41. https://doi.org/10.1097/ICU.0b013e32833eade6.
Zarbin MA, Jampol LM, Jager RD, et al. Ophthalmic evaluations in clinical studies of fingolimod (FTY720) in multiple sclerosis. Ophthalmology. 2013;120:1432–9. https://doi.org/10.1016/j.ophtha.2012.12.040.
Jain N, Bhatti MT. Fingolimod-associated macular edema: incidence, detection, and management. Neurology. 2012;78:672–80. https://doi.org/10.1212/WNL.0b013e318248deea.
Collongues N, Marignier R, Zéphir H, et al. Neuromyelitis optica in France: a multicenter study of 125 patients. Neurology. 2010;74:736–42. https://doi.org/10.1212/WNL.0b013e3181d31e35.
Yanagawa K, Kawachi I, Toyoshima Y, et al. Pathologic and immunologic profiles of a limited form of neuromyelitis optica with myelitis. Neurology. 2009;73:1628–37. https://doi.org/10.1212/WNL.0b013e3181c1deb9.
Bedi GS, Brown AD, Delgado SR, et al. Impact of rituximab on relapse rate and disability in neuromyelitis optica. Mult Scler. 2011;17:1225–30. https://doi.org/10.1177/1352458511404586.
Jacob A, Weinshenker BG, Violich I, et al. Treatment of neuromyelitis optica with rituximab: retrospective analysis of 25 patients. Arch Neurol. 2008;65:1443–8. https://doi.org/10.1001/archneur.65.11.noc80069.
Costanzi C, Matiello M, Lucchinetti CF, et al. Azathioprine: tolerability, efficacy, and predictors of benefit in neuromyelitis optica. Neurology. 2011;77:659–66. https://doi.org/10.1212/WNL.0b013e31822a2780.
Jacob A, Matiello M, Weinshenker BG, et al. Treatment of neuromyelitis optica with mycophenolate mofetil: retrospective analysis of 24 patients. Arch Neurol. 2009;66:1128–33. https://doi.org/10.1001/archneurol.2009.175.
Mealy MA, Wingerchuk DM, Palace J, et al. Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy. JAMA Neurol. 2014;71:324–30. https://doi.org/10.1001/jamaneurol.2013.5699.
Pittock SJ, Lennon VA, McKeon A, et al. Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study. Lancet Neurol. 2013;12:554–62. https://doi.org/10.1016/S1474-4422(13)70076-0.
Palace J, Leite MI, Nairne A, Vincent A. Interferon Beta treatment in neuromyelitis optica: increase in relapses and aquaporin 4 antibody titers. Arch Neurol. 2010;67:1016–7. https://doi.org/10.1001/archneurol.2010.188.
Shimizu J, Hatanaka Y, Hasegawa M, et al. IFNβ-1b may severely exacerbate Japanese optic-spinal MS in neuromyelitis optica spectrum. Neurology. 2010;75:1423–7. https://doi.org/10.1212/WNL.0b013e3181f8832e.
Balcer LJ, Frohman EM. Evaluating loss of visual function in multiple sclerosis as measured by low-contrast letter acuity. Neurology. 2010;74(Suppl 3):S16–23. https://doi.org/10.1212/WNL.0b013e3181dbb664.
MartĂnez-Lapiscina EH, Ortiz-PĂ©rez S, Fraga-Pumar E, et al. Colour vision impairment is associated with disease severity in multiple sclerosis. Mult Scler. 2014;20:1207–16. https://doi.org/10.1177/1352458513517591.
Zhao J, Dave SB, Wang J, Subramanian PS. Clinical color vision testing and correlation with visual function. Am J Ophthalmol. 2015;160:547–552.e1. https://doi.org/10.1016/j.ajo.2015.06.015.
Garcia-Martin E, Rodriguez-Mena D, Herrero R, et al. Neuro-ophthalmologic evaluation, quality of life, and functional disability in patients with MS. Neurology. 2013;81:76–83. https://doi.org/10.1212/WNL.0b013e318299ccd9.
Jasse L, Vukusic S, Durand-Dubief F, et al. Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability. Mult Scler. 2013;19(12):1618–26. https://doi.org/10.1177/1352458513479840.
Dasenbrock HH, Smith SA, Ozturk A, et al. Diffusion tensor imaging of the optic tracts in multiple sclerosis: association with retinal thinning and visual disability. J Neuroimaging. 2011;21:e41–9. https://doi.org/10.1111/j.1552-6569.2010.00468.x.
Fisher JB, Jacobs DA, Markowitz CE, et al. Relation of visual function to retinal nerve fiber layer thickness in multiple sclerosis. Ophthalmology. 2006;113:324–32. https://doi.org/10.1016/j.ophtha.2005.10.040.
Acknowledgements
This work is supported in part by a Challenge Grant to the Department of Ophthalmology, University of Colorado, from Research to Prevent Blindness, Inc.
Disclosure
Dr. Subramanian has no relevant financial disclosures.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Subramanian, P.S. (2020). Emerging Trends in Optic Neuritis and Associated Demyelinating Diseases. In: Chhablani, P. (eds) Neuro-ophthalmic Disorders. Current Practices in Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-13-8522-3_1
Download citation
DOI: https://doi.org/10.1007/978-981-13-8522-3_1
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-8521-6
Online ISBN: 978-981-13-8522-3
eBook Packages: MedicineMedicine (R0)