Optic Neuritis

Demyelinating optic neuritis is the most common cause of unilateral painful visualloss in the united states. although patients presenting with demyelinating opticneuritis have favorable long-term visual prognosis, optic neuritis is the initial clinicalmanifestation of multiple sclerosis in 20% of patients. the optic neuritis treatmenttrial (ontt) has helped stratify the risk of developing multiple sclerosis after thefirst episode of optic neuritis based on abnormal findings on brain mri. the onttalso demonstrated that while initial treatment of optic neuritis with intravenouscorticosteroids followed by an oral taper accelerates visual recovery, its use does notimprove long-term visual outcomes. long-term treatment with immunomodulatingagents such as interferons has been shown to improve clinical outcomes andneuroimaging abnormalities in multiple sclerosis; furthermore interferon use hasbeen associated with decreased risk of subsequent multiple sclerosis in patientswith an acute neurologic syndrome. however, several questions regarding thepresentation, management, and implications of acute demyelinating optic neuritisremain unanswered.