Advertisement

Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 277–282 | Cite as

Management of optic neuritis in Ireland: a survey comparing the management practices of acute demyelinating optic neuritis amongst ophthalmologists and neurologists in Ireland

  • Lina KobayterEmail author
  • Shivona Chetty
Original Article
  • 47 Downloads

Abstract

Background

Acute optic neuritis (ON) is often the first manifestation of multiple sclerosis which is particularly common in Ireland. Despite the specific clinical details regarding investigations and management of ON provided by the Optic Neuritis Treatment Trial (ONTT), international surveys have shown that there are still notable differences in the management of ON between neurologists and ophthalmologists.

Aim

To compare the investigation and treatment of acute optic neuritis between ophthalmologists and neurologists in Ireland

Method

A survey consisting of a case scenario and questions regarding treatment and investigations of a patient with ON was emailed to ophthalmology consultants, trainees and medical ophthalmologists registered with the Irish College of Ophthalmologists and to neurology consultants and registrars registered with the Irish Institute of Clinical Neuroscience.

Results

One hundred sixty recipients responded out of 350 (46%). The majority of the neurologists would initiate steroid treatment regardless of the patient’s vision (75%), treat with 1 g IV methylprednisolone (100%) for 5 days (57%), perform an MRI brain and orbits with contrast (92%) and multiple laboratory tests (96%). In contrast, the ophthalmologists tended to initiate treatment depending on the patient’s vision (48%), treat with 1 g IV methylprednisolone (97%) for 3 days instead of 5 days (93%), perform MRI brain and orbits with contrast (73%) and favour electrophysiology testing (73%) over laboratory testing (68%).

Conclusions

Overall, most respondents would follow the ONTT guidelines regarding IV methylprednisolone. There was a significant difference in responses between the ophthalmologists and neurologists regarding who to treat, duration of treatment and appropriate investigations.

Keywords

Demyelination Ireland Multiple sclerosis Optic neuritis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study and identifiable data remained anonymous throughout the study.

References

  1. 1.
    Lonergan R, Kinsella K, Fitzpatrick P, Brady J, Murray B, Dunne C, Hagan R, Duggan M, Jordan S, McKenna M, Hutchinson M, Tubridy N (2011) Multiple sclerosis prevalence in Ireland: relationship to vitamin D status and HLA genotype. J Neurol Neurosurg Psychiatry 82(3):317–322.  https://doi.org/10.1136/jnnp.2010.220988 CrossRefGoogle Scholar
  2. 2.
    McGuigan C, McCarthy A, Quigley C, Bannan L, Hawkins SA, Hutchinson M (2004) Latitudinal variation in the prevalence of multiple sclerosis in Ireland, an effect of genetic diversity. J Neurol Neurosurg Psychiatry 75(4):527–576.  https://doi.org/10.1136/jnnp.2003.012666 CrossRefGoogle Scholar
  3. 3.
    Beck RW, Gal RL (2008) Treatment of acute optic neuritis: a summary of findings from the optic neuritis treatment trial. Arch Ophthalmol 126(7):994–995.  https://doi.org/10.1001/archopht.126.7.994 CrossRefGoogle Scholar
  4. 4.
    Brodsky M, Nazarian S, Orengo-Nania S et al (2008) The Optic Neuritis Study Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment follow-up. Arch Neurol 65(6):727–732.  https://doi.org/10.1001/archneur.65.6.727 Google Scholar
  5. 5.
    Beck RW, Cleary PA, Trobe JD, Kaufman DI, Kupersmith MJ, Paty DW, Brown CH (1993) The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. N Engl J Med 329:1764–1769.  https://doi.org/10.1056/NEJM/1993120932922403 CrossRefGoogle Scholar
  6. 6.
    Beck RW, Arrington J, Reed Murtagh F et al (1993) Brain magnetic resonance imaging in acute optic neuritis. Arch Neurol 50(8):841–846.  https://doi.org/10.1001/archneur.1993.00540080050013 CrossRefGoogle Scholar
  7. 7.
    Beck RW, Cleary PA, Backlund J et al (1994) The course of visual recovery after optic neuritis. Ophthalmology 101:1771–1778.  https://doi.org/10.1016/S0161-6420(94)31103-1 CrossRefGoogle Scholar
  8. 8.
    Ghosh A, Kelly SP, Mathews J, Cooper PN, Macdermott N (2002) Evaluation of the management of optic neuritis: audit on the neurological and ophthalmological practice in the north west of England. J Neurol Neurosurg Psychiatry 71:119–121.  https://doi.org/10.1136/jnnp.72.1.119 CrossRefGoogle Scholar
  9. 9.
    Biousse V, Calvetti O, Drews-Botsch CD, Atkins EJ, Sathornsumetee B, Newman NJ, Optic Neuritis Survey Group (2009) Management of optic neuritis and impact of clinical trials: an international survey. J Neurol Sci 275(1–2):69–74.  https://doi.org/10.1016/j.jns.2008.08.039 CrossRefGoogle Scholar
  10. 10.
    Atkins EJ, Drews-Botsch CD, Newman NJ, Calvetti O, Swanson S, Biousse V (2008) Management of optic neuritis in Canada: survey of ophthalmologists and neurologists. Can J Neurol Sci 35(2):179–184.  https://doi.org/10.1017/S031716710000860X CrossRefGoogle Scholar
  11. 11.
    Lueck CJ, Danesh-Meyer HV, Margrie FJ, Drews-Botsch C, Calvetti O, Newman NJ, Biousse V (2008) Management of acute optic neuritis: a survey of ophthalmologists and neurologists in Australia and New Zealand. J Clin Neurosci 15(3):1340–1345.  https://doi.org/10.1016/j.jocn.2008.01.014 CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  1. 1.Ophthalmology DepartmentSligo University HospitalSligoIreland

Personalised recommendations