Should patients with optic neuritis be treated with steroids?

PURPOSE OF REVIEW: Optic neuritis is the most common cause of optic neuropathy in young adults. High-dose intravenous corticosteroids (IVCS) were established as the standard of treatment for acute optic neuritis via the Optic Neuritis Treatment Trial (ONTT), with its first findings published more than 20 years ago. Subsequent studies have further clarified the role of corticosteroids in the treatment of acute optic neuritis.

RECENT FINDINGS: Recent clinical research has confirmed existing knowledge of the efficacy and limitations of corticosteroids in the treatment of optic neuritis. Recent studies have examined the role of race, route of administration and combination of IVCS with other therapies. Current evidence continues to support high-dose IVCS as the cornerstone of treatment of acute optic neuritis.

SUMMARY: High-dose IVCS are effective in hastening visual recovery in acute typical optic neuritis, but do not affect the final visual outcome. In optic neuritis patients, IVCS may delay progression to clinically definite multiple sclerosis (CDMS) at 2 years, but not at 5 or 10 years. It is reasonable to recommend high-dose IVCS for acute optic neuritis patients with significant vision loss, severe pain and/or white matter lesions on brain MRI in whom the potential for benefit outweighs the risks.