Complications
There is a risk of conversion to clinically definite multiple sclerosis (CDMS), which depends on the presence of an abnormal MRI at presentation.
A number of studies have investigated the risk of conversion to MS after optic neuritis (ON). The 15-year results of the Optic Neuritis Treatment Trial (ONTT) showed that overall the cumulative probability was 50%. Of patients with no MRI lesions, 25% developed MS, whereas 72% with 1 or more lesions on the initial scan developed MS.[71][72]
Disease-modifying treatments for MS have been shown to reduce the frequency of relapses in established MS.[73] There is also evidence supporting reduced risk of progression to CDMS with immunomodulatory treatment of clinically isolated syndrome (CIS), including ON.[74][75][76][77]
Any patient who has had ON has a risk of recurrence. This risk seems to be increased by treatment with oral corticosteroids (but not intravenous corticosteroids). The risk of recurrence of ON in the affected or fellow eye is approximately 30% at 5 years.
There is no treatment for idiopathic ON other than pulse dose corticosteroids. This treatment has been documented to improve vision more rapidly than natural history but not more completely. In the ONTT, 92% of patients had visual acuity of 20/40 or better at 5 years; visual prognosis in ON is generally good.[20]
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