Skip to main content

Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months.

Publication ,  Journal Article
Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), ; Pineles, SL; Repka, MX; Liu, GT; Waldman, AT; Borchert, MS; Khanna, S ...
Published in: JAMA Ophthalmol
December 1, 2020

IMPORTANCE: Optic neuritis (ON) in children is uncommon. There are limited prospective data for visual acuity (VA) outcomes, associated diseases, and neuroimaging findings. Prospective data from a large sample would be useful for counseling families on treatment decisions and prognosis. OBJECTIVE: To prospectively study children with a first episode of ON, describe VA after 6 months, and ascertain the network's (Pediatric Eye Disease Investigator Group and Neuro-Ophthalmology Research Disease Investigator Consortium) ability to enroll pediatric patients with ON prospectively. DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized cohort study was conducted from September 20, 2016, to July 20, 2018, at 23 sites in the United States and Canada in pediatric ophthalmology or neuro-ophthalmology clinics. A total of 44 children (aged 3-15 years) presented with a first episode of ON (visual loss, pain on eye movements, or both) within 2 weeks of symptom onset and at least 1 of the following in the affected eye: a distance high-contrast VA (HCVA) deficit of at least 0.2 logMAR below age-based norms, diminished color vision, abnormal visual field, or optic disc swelling. Exclusion criteria included preexisting ocular abnormalities or a previous episode of ON. MAIN OUTCOMES AND MEASURES: Primary outcomes were monocular HCVA and low-contrast VA at 6 months. Secondary outcomes were neuroimaging, associated diagnoses, and antibodies for neuromyelitis optica and myelin oligodendrocyte glycoprotein. RESULTS: A total of 44 children (mean age [SD], 10.2 [3.5] years; 26 boys [59%]; 23 White individuals [52%]; 54 eyes) were enrolled in the study. Sixteen patients (36%) had bilateral ON. Magnetic resonance imaging revealed white matter lesions in 23 children (52%). Of these children, 8 had myelin oligodendrocyte glycoprotein-associated demyelination (18%), 7 had acute disseminated encephalomyelitis (16%), 5 had multiple sclerosis (11%), and 3 had neuromyelitis optica (7%). The baseline mean HCVA was 0.95 logMAR (20/200), which improved by a mean 0.76 logMAR (95% CI, 0.54-0.99; range, -0.70 to 1.80) to 0.12 logMAR (20/25) at 6 months. The baseline mean distance low-contrast VA was 1.49 logMAR (20/640) and improved by a mean 0.72 logMAR (95% CI, 0.54-0.89; range, -0.20 to 1.50) to 0.73 logMAR (20/100) at 6 months. Baseline HCVA was worse in younger participants (aged <10 years) with associated neurologic autoimmune diagnoses, white matter lesions, and in those of non-White race and non-Hispanic ethnicity. The data did not suggest a statistically significant association between baseline factors and improvement in HCVA. CONCLUSIONS AND RELEVANCE: The study network did not reach its targeted enrollment of 100 pediatric patients with ON over 2 years. This indicates that future treatment trials may need to use different inclusion criteria or plan a longer enrollment period to account for the rarity of the disease. Despite poor VA at presentation, most children had marked improvement by 6 months. Associated neurologic autoimmune diagnoses were common. These findings can be used to counsel families about the disease.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

December 1, 2020

Volume

138

Issue

12

Start / End Page

1253 / 1261

Location

United States

Related Subject Headings

  • White Matter
  • Visual Acuity
  • United States
  • Prospective Studies
  • Optic Neuritis
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Female
  • Child, Preschool
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), ., Pineles, S. L., Repka, M. X., Liu, G. T., Waldman, A. T., Borchert, M. S., … Holmes, J. M. (2020). Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months. JAMA Ophthalmol, 138(12), 1253–1261. https://doi.org/10.1001/jamaophthalmol.2020.4231
Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), Jonathan M., Stacy L. Pineles, Michael X. Repka, Grant T. Liu, Amy T. Waldman, Mark S. Borchert, Sangeeta Khanna, et al. “Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months.JAMA Ophthalmol 138, no. 12 (December 1, 2020): 1253–61. https://doi.org/10.1001/jamaophthalmol.2020.4231.
Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), Pineles SL, Repka MX, Liu GT, Waldman AT, Borchert MS, et al. Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months. JAMA Ophthalmol. 2020 Dec 1;138(12):1253–61.
Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), Jonathan M., et al. “Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months.JAMA Ophthalmol, vol. 138, no. 12, Dec. 2020, pp. 1253–61. Pubmed, doi:10.1001/jamaophthalmol.2020.4231.
Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG), Pineles SL, Repka MX, Liu GT, Waldman AT, Borchert MS, Khanna S, Heidary G, Graves JS, Shah VS, Kupersmith MJ, Kraker RT, Wallace DK, Cotter SA, Holmes JM. Assessment of Pediatric Optic Neuritis Visual Acuity Outcomes at 6 Months. JAMA Ophthalmol. 2020 Dec 1;138(12):1253–1261.

Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

December 1, 2020

Volume

138

Issue

12

Start / End Page

1253 / 1261

Location

United States

Related Subject Headings

  • White Matter
  • Visual Acuity
  • United States
  • Prospective Studies
  • Optic Neuritis
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Female
  • Child, Preschool