Microsoft word - issue 14, june 2003 od version .doc
April 2003 icanseeclearly.com June 2003 The Best VisioNewsletter Optic Neuritis and Early Multiple Sclerosis (MS) Prediction Erdey Eye Group
Ocular clinicians play an important role in the diagnosis of MS since ocular findings are often the presenting sign.
High clinical suspicion for optic neuritis remains our best ally to identify this condition. Recent evidence provides
hope that treatment of optic neuritis may, under certain circumstances, significantly reduce subsequent
Optic neuritis typically presents with unilateral vision loss (ranging from subtle to profound), color vision loss,
orbital pain (particularly with eye movement), and relative afferent pupillary defect. Only one third of adult optic
Richard A Erdey MD
neuritis patients demonstrate papillitis evidenced by a swol en optic nerve with or without peripapil ary flame-
shaped hemorrhages. The remaining two thirds of adult optic neuritis patients have retrobulbar involvement
Gregory D Searcy MD
characterized by normal optic disc appearance. Visual field defects most commonly demonstrate central scotoma,
but centrocecal or nerve fiber bundle defects are also possible.
Patrick A Janson OD
MS is usually heralded by a single clinical demyelinating event involving the optic nerve, spinal cord, cerebel um, or
brain stem. Thus optic neuritis may very well be the first clinical indicator of MS in many patients. Further workup
Stacie L Errington OD
of these patients would include a complete neurological examination and a detailed history. Previous episodes of
optic neuritis, headaches, nausea, a history of episodic neurological deficits with heat and exercise (Uthoff’s sign),
Kasey J Eppley OD
diplopia, patchy paresthesias, ataxia, or vertigo are all suggestive of MS.
The Optic Neuritis Treatment Trial (ONTT) demonstrated that IV methylprednisolone hastens visual recovery but
Matthew U Neal OD
does not improve final visual acuity compared to observation. ONTT assigned 457 patients with acute optic
neuritis into 3 treatment categories: IV methylprednisolone followed by oral prednisone, oral prednisone alone, or
Douglas Bosner OD
oral placebo. Oral prednisone offered no long-term improvement in visual outcome compared to observation, and
doubled the recurrence rate of optic neuritis. IV methylprednisolone delayed the development of further
Pamela J Andrews
neurological events consistent with MS and hastened visual recovery of optic neuritis, though at one-year fol ow-up
and thereafter there was no significant difference in visual recovery among the three groups. The Controlled High-Risk Subjects Avonex Prevention Study (CHAMPS) followed 383 patients with the first attack of an acute demyelinating event, such as optic neuritis, who had subclinical demyelination on an MRI scan. CHAMPS
patients received initial IV methylprednisolone, and then were randomized to receive Avonex (interferon beta-1a) or placebo. After 3 years, the probability of developing clinically definite MS was 44% lower in the treatment
In summary, a keen index of suspicion for optic neuritis is important since many MS patients present with visual
symptoms but the majority of adults with this condition have normal optic nerve appearance. MRI and
neurological referral are paramount to determine if patients would benefit from IV methylprednisolone and Avonex
to reduce their chance of subsequent MS.
¾ Ocular Clinicians Play an Integral and Important Medical Role in the
¾ Ocular Findings are Often the Presenting Signs of Multiple Sclerosis.
¾ Recent Evidence Indicates that Treatment of Optic Neuritis May
Significantly Reduce the Subsequent Development of Multiple Sclerosis.
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A Randomized, Placebo-Controlled Trial of Sertraline in the Treatment of Night Eating Syndrome John P. O’Reardon, M.D. Objective: The authors assessed the effi- placebo. Twelve subjects in the sertralinegroup (71%) were classified as having re- Kelly C. Allison, Ph.D. sponded (CGI improvement rating ≤2, in-dicating much or very much improved) Method: Thirty-four outpatients
Keweenaw Holistic Family Medicine Pediatric Intake FormParents marital status (circle): Married / Separated / Living Together / Other:Current Grade in School:Please indicate the severity of your symptoms by checking the box that applies to each symptom (sx). Part I: ENT - Allergy Symptoms Mild Moderate Severe Moderate Severe Moderate No Sx Mild Sx No Sx Mild Sx Severe Sx