Optic Neuritis

Lyon · Post by **Lyon** » Fri Apr 18, 2008 9:56 am

.
Bob

EyeDoc · Post by **EyeDoc** » Fri Apr 18, 2008 1:36 pm

Lyon wrote:Hi EyeDoc and Grumpster,
I know that one article doesn't constitute conclusive evidence but take a minute to read that article I posted above http://tinyurl.com/5zzdph before I cut the link in a day or so.

I am not qualified to agree or disagree with their findings this isn't the only time I've read that same opinion.

After the initial period of recovery after an acute episode of
optic neuritis, visual acuity remained stable in most patients
over 15 years. Treatment of acute optic neuritis with high-dose
intravenous corticosteroids does not alter the long-term visual
course, although it shortens the initial recovery period.2
Bob

There is essentially two ways to go about ON treatment...to treat or not to treat. In a first time ON patient that shows at least one area of demyelination on MRI it is considered standard of care to begin treatment with IV and oral steroids. The treatment decreases recurrence of ON and shortens the duration of visual impairment. Even so, it is known that the long term visual-outcome is no different than without treatment as spontaneous recovery if the natural course in most cases. On a patient with a prior diagnosis of MS has been made, observation (no treatment) is fine.

So that is the "by the book" treatment modality we use. Now comes the hard part: as with most things in life, nothing is necessarily by the book. Put yourself into the shoes of a patient with decreasing vision and pain. They go to their doctor for help. Is it most helpful to that patient to withold treatment that will decrease the severity and length of their ON just because you can? In my opinion, absolutely not.

The question of whether or not decreasing inflammation can be protective to the nerve in the long run is unsettled. There are numerous research articles that will argue both sides of the coin. Personally, I feel that reducing inflammation in the acute phase of optic neuritis can be neuroprotective, and treatment certainly reduces a patient's symptoms and vision difficulties. As an MS patient and eyedoc that is good enough for me

Lyon · Post by **Lyon** » Fri Apr 18, 2008 2:00 pm

MrsGeorge · Post by **MrsGeorge** » Fri Apr 18, 2008 10:44 pm

Glad your wife would have some choice Lyon - I was told outright thta they just don't treat it in the NHS - they wait and see and only if it doesn't get better of it's own volition will they start treatment!

EyeDoc · Post by **EyeDoc** » Sat Apr 19, 2008 6:21 am

MrsGeorge wrote:Glad your wife would have some choice Lyon - I was told outright thta they just don't treat it in the NHS - they wait and see and only if it doesn't get better of it's own volition will they start treatment!

I am really sorry about this, MrsGeorge. It is puzzling and frustrating to me that they would not begin treatment on you immediately upon diagnosis. Forget about the idea of possibly preventing the frequency of reoccurrences....what about helping the patient return to functional vision? I know from personal experience that my vision was so poor I was unable to do my job effectively, much less drive safely to and from work. Within days of treatment my vision was back to "normal" levels. Without it I may have languished weeks or months. What is the point of making a patient go through this when a cheap and easily administered treatment is readily available to help the patient? That is a rhetorical question as I know the answer is one none of us can give. Whether this is a problem with universal health care or just stubborn doctors, it is an interesting question to me

MrsGeorge · Post by **MrsGeorge** » Sat Apr 19, 2008 9:16 am

I wish I could answer it - but they caught it pretty early and the doc even told me that it would probably get worse over the week before it started getting better but not to worry about it!

It's ridiculous!

g123 · Post by **g123** » Sat Apr 19, 2008 10:51 am

MrsGeorge wrote:Glad your wife would have some choice Lyon - I was told outright thta they just don't treat it in the NHS - they wait and see and only if it doesn't get better of it's own volition will they start treatment!

That is interesting that they told you they would treat it later, if it didn't get better. They told me they couldn't treat mine because there was only a short window (10 days?) to treat it, and I sought treatment too late. If I got it again, unless it affected both eyes, I wouldn't treat it anyway.

AllyB · Post by **AllyB** » Sat Apr 19, 2008 12:04 pm

Hi there

g123 - I was told the same as you - I waited too long in getting treatment and I was already 2 weeks into ON before I saw an Opthalmologist. I had seen my neuro just a couple of days into the attack, and he was a bit uncertain if I had ON - after checking with this forum, eyedoc advised that only an eye specialist could effectively diagnose ON and that I should see an Opthalmologist just to be safe - so I made an appointment, but by the time I saw him, he felt it was too late for IV steroids. If it happens again, he told me to go straight to his rooms and not to bother with an appointment, he would see me immediately!

So mrs.G - your docs approach is different! The good old NHS...

I kind of like the idea of iv steroids for an ms relapse - to my mind, despite research to the contrary, it seems logical that reducing inflammation asap would give your cns a better chance at recovery, at least in the short term. I didn't really know for sure that I had ON (thought it might be middle age causing the blurred vision and a bad headache causing the pain on moving the eye), but if I ever get it again, I will seek treatment asap - our eyedoc forum member makes perfect sense to me.

Thanks everyone & I hope your ON clears up real quick.