Optic neuritis in adults and children

Most ophthalmologists will encounter optic neuritis in the course of their practice. The disease behaves very differently in children versus adults. The ONTT and CHAMPS trials have given us important data regarding prognosis and management in adults, including probability of developing MS. Optic neuritis in children, while less common, must be considered in the differential diagnosis of subacute visual loss, especially in children with bilateral impairment. Secondary causes of optic neuritis are more common in children and an investigation should be performed to assess for associated disease states. In both populations, the ophthalmologist will play a central role in the diagnosis, treatment, and management of these patients, whether it is an isolated case of optic neuritis or the initial presentation of a long-term struggle with MS. With the advent of immunomodulating therapy to minimize both the subsequent incidence and severity of MS, early diagnosis and appropriate management by the ophthalmologist has become even more critical.