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Published on: April 14, 2014
Visual outcomes in pediatric optic neuritis
Michael J Wan1, Olumuyiwa Adebona1, Leslie A Benson2
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Most children with first-episode optic neuritis achieve good vision within a year. Early visual acuity at three months is the main predictor of long-term visual outcomes in pediatric optic neuritis patients.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Optic neuritis is an inflammatory condition affecting vision in children.
- Understanding visual outcomes is crucial for managing pediatric optic neuritis.
Purpose of the Study:
- To describe the visual outcomes in a large cohort of pediatric patients with first-episode optic neuritis.
- To identify risk factors for poor visual outcomes and analyze the time course of visual recovery.
Main Methods:
- Retrospective, observational cohort study of pediatric patients with first-episode optic neuritis.
- Follow-up in ophthalmology department for at least 3 months over a 10-year period.
- Main outcome measures included visual acuity at 3 months and 1 year.
Main Results:
- 81% of pediatric patients achieved at least 20/20 vision by 1 year.
- Vision of <20/20 at 3 months was associated with poor visual outcome at 1 year (P=0.041).
- Baseline characteristics like sex, bilateral involvement, and underlying diagnoses were not significant predictors of poor outcomes.
Conclusions:
- The majority of pediatric patients with optic neuritis regain normal visual acuity by 1 year.
- Visual recovery is generally favorable, irrespective of initial clinical features.
- Early visual acuity is a key indicator for predicting long-term vision in pediatric optic neuritis.
Purpose:
To describe the visual outcomes of a large cohort of pediatric patients presenting to a tertiary care pediatric hospital with first-episode optic neuritis.
Design:
Retrospective, observational cohort study.
Methods:
In a tertiary care pediatric hospital, patients with first-episode optic neuritis and at least 3 months of follow-up over a 10-year period were assessed and followed-up in the ophthalmology department. The main outcome measures were visual acuity at 3 months and 1 year of follow-up, with analysis of risk factors for poor visual outcomes and the time course of visual recovery.
Results:
Of the 59 pediatric patients with first-episode optic neuritis, 46 had at least 3 months of follow-up and 36 had at least 1 year of follow-up. The mean age was 12.6 years old; 72% were female, 41% had bilateral involvement, 52% had or developed an underlying diagnosis (39% multiple sclerosis, 7% acute disseminated encephalomyelitis, 7% neuromyelitis optica), and 91% received treatment (85% steroids, 7% multimodal). At 1 year, 81% were at least 20/20 and 89% were at least 20/40. A poor visual outcome at 1 year (<20/40) was associated with vision of <20/20 at 3 months (P = 0.041). Other clinical characteristics, including visual acuity at presentation, sex, bilateral involvement, optic nerve edema, and underlying diagnoses were not significantly associated with poor visual outcomes.
Conclusions:
In this cohort of pediatric patients with optic neuritis, the majority of patients regained normal visual acuity at 1 year, regardless of baseline clinical characteristics.
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