Treatment of optic neuritis has changed in recent years, due to a landmark series of studies known as the Optic Neuritis Treatment Trials (ONTT).
In these studies, people with optic neuritis were randomized for treatment with intravenous (IV) steroids, oral steroids or placebo. Afterward they were evaluated for several years.
From these studies, researchers learned that treatment with steroids had little effect on the final visual outcome in patients with optic neuritis.
However, patients treated with IV steroids had fewer repeat attacks of optic neuritis than patients treated with oral steroids alone. In fact, those treated with oral steroids alone had a higher risk of repeat attacks of optic neuritis than those treated with placebo.
Even more importantly, patients treated initially with IV steroids had about half the risk of developing MS in two years as patients treated with oral steroids only, or placebo. Of those treated with IV (followed by oral) steroids, 7.5 percent developed MS in the following two years, versus about 16 percent in the other groups.
As a result of the ONTT, eye doctors now treat patients with optic neuritis with either IV — followed by oral steroids — or no treatment at all. No patients are treated with oral steroids alone. For those who are treated, the regimen typically includes three days of IV steroids, followed by about 11 days of oral steroids.
Prognosis for Those Who Have Optic Neuritis
Visual deficits caused by optic neuritis may worsen over a period of about seven days before vision typically stabilizes at that level for three to eight weeks. Gradual vision improvement then may occur.
About 95 percent of people with optic neuritis will recover much of their vision within six months of onset. However, about 19 percent will have a recurrence of optic neuritis in the affected eye, and 17 percent will develop optic neuritis in the other eye within 10 years.
As mentioned above, sometimes optic neuritis is a precursor to development of MS, so if you have optic neuritis, your doctor may recommend an MRI. If imaging shows "white matter" lesions indicating damage to myelin in nerve fibers, there is a 56 percent chance of developing MS within 10 years. But even with normal results, a person with optic neuritis has a 22 percent chance of developing MS.
