Abstract
Objective
1) To evaluate the management of acute isolated optic neuritis (ON) by ophthalmologists
and neurologists; 2) to evaluate the impact of clinical trials; 3) to compare these
practices among 7 countries.
Methods
A survey on diagnosis and treatment of acute isolated ON was sent to 5443 neurologists
and 6099 ophthalmologists in the southeast-USA, Canada, Australia/New Zealand, Denmark,
France, and Thailand. USA data were compared to those of other countries.
Results
We collected 3142 surveys (1449 neurologists/1693 ophthalmologists) (29.8% response
rate). In all countries, ON patients more frequently presented to ophthalmologists,
and were subsequently referred to neurologists or subspecialists. Evaluation and management
of ON varied among countries, mostly because of variations in healthcare systems,
imaging access, and local guidelines. A brain MRI was obtained for 70–80% of ON patients;
lumbar punctures were obtained mostly in Europe and Thailand. Although most patients
received acute treatment with intravenous steroids, between 14% and 65% of neurologists
and ophthalmologists still recommended oral prednisone (1 mg/kg/day) for the treatment
of acute isolated ON. In all countries, steroids were often prescribed to improve
visual outcome or to decrease the long-term risk of multiple sclerosis.
Interpretation
Although recent clinical trials have changed the management of acute ON around the
world, many neurologists and ophthalmologists do not evaluate and treat acute ON patients
according to the best evidence from clinical research. This confirms that evaluation
of the impact of major clinical trials (“translational T2 clinical research”) is essential
when assessing the effects of interventions designed to improve quality of care.
Keywords
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Article info
Publication history
Accepted:
August 26,
2008
Received in revised form:
August 22,
2008
Received:
June 16,
2008
Identification
Copyright
© 2008 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
