Research Article| Volume 312, ISSUE 1-2, P21-25, January 15, 2012

Download started.


Optic neuritis in an ethnically diverse population: Higher risk of atypical cases in patients of African or African-Caribbean heritage

Published:September 19, 2011DOI:



      To investigate the presence of an ethnicity bias within patients presenting with optic neuritis in London.


      Observational cross-sectional study.


      The ethnicity profile of all patients attending a neuro-ophthalmology clinic in central London with acute optic neuritis over a 16 month period (n=86) was studied. A comparison was made with the ethnicity profile of the population of London as well as patients with Multiple Sclerosis-associated optic neuritis (n=41), Neuromyelitis Optica spectrum disorder-associated optic neuritis (n=27) and patients with an atypical corticosteroid-dependent optic neuropathy (21).


      The ethnicity profile of the patient cohort presenting to our clinic with acute optic neuritis over a 16 month period closely matched the ethnicity profile of London (P=0.08). Within this cohort, patients of African or African-Caribbean heritage were found to be more likely to manifest either a pattern or aetiology of optic neuritis requiring immunosuppressive treatment in comparison with patients of a white Caucasian background (relative risk 3.47; 95% CI=1.092 to 11.007). There was a disproportionately high representation of patients from an African or African-Caribbean background within the Neuromyelitis Optica spectrum-related optic neuritis diagnostic group (P<0.00).


      Patients with acute isolated optic neuritis from African or African Caribbean backgrounds are over 3 times more likely than patients of white Caucasian backgrounds to have an ‘atypical’ pattern of optic neuritis where corticosteroid therapy may be required. Our results suggest that a patient's ethnic background is an important factor to be taken into consideration when deciding on the diagnosis and management of acute isolated optic neuritis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bhigjee A.I.
        • Moodley K.
        • Ramkissoon K.
        Multiple sclerosis in KwaZulu Natal, South Africa: an epidemiological and clinical study.
        Mult Scler. Nov 2007; 13: 1095-1099
        • Zelnik N.
        • Gale A.D.
        • Shelburne Jr., S.A.
        Multiple sclerosis in black children.
        J Child Neurol. Jan 1991; 6: 53-57
        • Kira J.
        Neuromyelitis optica and opticospinal multiple sclerosis: mechanisms and pathogenesis.
        Pathophysiology. Feb 2011; 18: 69-79
        • Asgari N.
        • Lillevang S.T.
        • Skejoe H.P.
        • Falah M.
        • Stenager E.
        • Kyvik K.O.
        A population-based study of neuromyelitis optica in Caucasians.
        Neurology. May 3 2011; 76: 1589-1595
        • Cabre P.
        • Gonzalez-Quevedo A.
        • Lannuzel A.
        • Bonnan M.
        • Merle H.
        • Olindo S.
        • et al.
        Descriptive epidemiology of neuromyelitis optica in the Caribbean basin.
        Rev Neurol (Paris). Aug-Sep 2009; 165: 676-683
        • Cabrera-Gómez J.A.
        • Kurtzke J.F.
        • González-Quevedo A.
        • Lara-Rodríguez R.
        An epidemiological study of neuromyelitis optica in Cuba.
        J Neurol. Jan 2009; 256: 35-44
        • Wingerchuk D.M.
        • Lennon V.A.
        • Lucchinetti C.F.
        • Pittock S.J.
        • Weinshenker B.G.
        The spectrum of neuromyelitis optica.
        Lancet Neurol. 2007; 6: 805-815
      1. The 5-year risk of MS after optic neuritis. Experience of the optic neuritis treatment trial. Optic Neuritis Study Group.
        Neurology. Nov 1997; 49: 1404-1413
        • Lennon V.A.
        • Wingerchuk D.M.
        • Kryzer T.J.
        • Pittock S.J.
        • Lucchinetti C.F.
        • Fujihara K.
        • et al.
        A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis.
        Lancet. Dec 11–17 2004; 364: 2106-2112
        • Wingerchuk D.M.
        • Lennon V.A.
        • Pittock S.J.
        • Lucchinetti C.F.
        • Weinshenker B.G.
        Revised diagnostic criteria for neuromyelitis optica.
        Neurology. 2006; 66: 1485-1489
        • Nakamura M.
        • Nakazawa T.
        • Doi H.
        • Hariya T.
        • Omodaka K.
        • Misu T.
        • et al.
        Early high-dose intravenous methylprednisolone is effective in preserving retinal nerve fiber layer thickness in patients with neuromyelitis optica.
        Graefes Arch Clin Exp Ophthalmol. Dec 2010; 248: 1777-1785
      2. London: Resident population estimates by ethnic group. Office for National Statistics Neighbourhood Statistics. Retrieved Aug 2009.

        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann Neurol. Feb 2011; 69: 292-302
        • Kupersmith M.J.
        • Burde R.M.
        • Warren F.A.
        • Klingele T.G.
        • Frohman L.P.
        • Mitnick H.
        Autoimmune optic neuropathy: evaluation and treatment.
        J Neurol Neurosurg Psychiatry. Nov 1988; 51: 1381-1386
      3. Erratum.
        in: J Neurol Neurosurg Psychiatry. 52(5). May 1989: 692
        • Kidd D.
        • Burton B.
        • Plant G.T.
        • Graham E.M.
        Chronic relapsing inflammatory optic neuropathy (CRION).
        Brain. Feb 2003; 126: 276-284
        • Waters P.
        • Jarius S.
        • Littleton E.
        • Leite M.I.
        • Jacob S.
        • Gray B.
        • et al.
        Aquaporin-4 antibodies in neuromyelitis optica and longitudinally extensive transverse myelitis.
        Arch Neurol. Jul 2008; 65: 913-919
        • Deschamps R.
        • Paturel L.
        • Jeannin S.
        • Chausson N.
        • Olindo S.
        • Béra O.
        • et al.
        Different HLA class II (DRB1 and DQB1) alleles determine either susceptibility or resistance to NMO and multiple sclerosis among the French Afro-Caribbean population.
        Mult Scler. Jan 2011; 17: 24-31
        • Petzold A.
        • Pittock S.
        • Lennon V.
        • Maggiore C.
        • Weinshenker B.G.
        • Plant G.T.
        Neuromyelitis optica-IgG (aquaporin-4) autoantibodies in immune mediated optic neuritis.
        J Neurol Neurosurg Psychiatry. Jan 2010; 81: 109-111
        • Rees P.
        • Butt F.
        Ethnic change and diversity in England, 1981–2001.
        Area. 2004; 36.2: 174-186
        • Phillips P.H.
        • Newman N.J.
        • Lynn M.J.
        Optic neuritis in African Americans.
        Arch Neurol. Feb 1998; 55: 186-192
        • Beck R.W.
        • Cleary P.A.
        Optic neuritis treatment trial. One-year follow-up results.
        Arch Ophthalmol. Jun 1993; 111: 773-775
        • Ghosh A.
        • Kelly S.P.
        • Mathews J.
        • Cooper P.N.
        • Macdermott N.
        Evaluation of the management of optic neuritis: audit on the neurological and ophthalmological practice in the north west of England.
        J Neurol Neurosurg Psychiatry. Jan 2002; 72: 119-121
        • Shimizu J.
        • Hatanaka Y.
        • Hasegawa M.
        • Iwata A.
        • Sugimoto I.
        • Date H.
        • et al.
        IFNβ-1b may severely exacerbate Japanese optic-spinal MS in neuromyelitis optica spectrum.
        Neurology. Oct 19 2010; 75: 1423-1427