Stacy L. Pineles
SAN DIEGO — Low contrast visual acuity is severely affected in pediatric patients with optic neuritis, and even though it generally improves, it does not achieve normal levels, according to a study.
Optic neuritis is well studied in adults but not in children, Stacy L. Pineles, MD, MS, said at the American Association for Pediatric Ophthalmology and Strabismus annual meeting. Therefore, she and colleagues, as a collaboration between the Pediatric Eye Disease Investigator Group and the Neuro-Ophthalmology Research Disease Investigator Consortium, undertook an effort to determine the feasibility of enrolling children in a pediatric optic neuritis research protocol and to evaluate visual acuity outcomes 6 months after enrollment.
“This is the first prospective study of visual acuity outcomes in pediatric optic neuritis,” Pineles said. “We found that these patients were pretty commonly associated with neurological syndromes. There’s a marked improvement in distance visual acuity in most of the eyes, [and] patients with MRI lesions seemed to have worse visual acuity at presentation.”
Fifty-four eyes of 44 children aged 3 through 15 years with symptom onset within 2 weeks were recruited.
“Most patients presented with isolated optic neuritis, and within that group, there were more unilateral than bilateral [cases],” Pineles said. “There was optic disc edema in three-quarters (74%) of eyes, and the median distance visual acuity was 20/200, which is pretty terrible, with 30% of patients having worse than 20/800 at presentation and equally bad low contrast vision.”
In contrast, in the Optic Neuritis Treatment Trial in adults, only one-third had optic disc edema and the median visual acuity was 20/80, she said.
Of 37 children and 45 eyes completing the 6-month visit, there was marked improvement in visual acuity; the percentage of these eyes with normal visual acuity at enrollment was 20% and at 6 months was 76%. Median visual acuity was 20/100 at enrollment, improving to 20/20 at 6 months. Eyes with “really bad vision,” worse than 20/200 and worse than 20/800 at enrollment, improved from 48% and 26%, respectively, to 5% and 2% at 6 months, she said.
“Most patients, regardless of how bad their vision was at enrollment, improved to better than 20/30. So there was no relationship between how bad their vision was at enrollment and how bad or good their vision was at 6 months,” Pineles said.
Pineles also delivered the Young Investigator’s Award Paper on “The Functional Impact of Strabismus” at the AAPOS meeting. – by Patricia Nale, ELS
Pineles SL. A prospective outcomes study of pediatric optic neuritis. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; March 28 to 31, 2019; San Diego.
Disclosure: Pineles reports no relevant financial disclosures.