Management of isolated optic neuritis in France: Survey of neurologists and ophthalmologists

Background. - Acute isolated optic neuritis is often the first manifestation of multiple sclerosis (MS). Despite the results of several clinical trials its management remains controversial. With the advent of new disease-modifying agents for the treatment of MS, management of isolated optic neuritis has become more complicated. The goal of this study was to evaluate the current clinical practice of French ophthalmologists and neurologists in the management of acute isolated optic neuritis, and to evaluate the impact of recently published randomized clinical trials on their practice. Methods. - A survey, including 24 questions on the diagnosis and treatment of acute isolated optic neuritis was sent to all neurologists and to a sample of ophthalmologists in France. Results. - The responses of 655 neurologists and 141 ophthalmologists were analyzed. This study shows mostly that patients initially present more frequently to ophthalmologists, and are subsequently referred to neurologists. Most optic neuritis patients undergo a brain MRI and a lumbar puncture. Although most patients receive high dose intravenous steroids, up to 15% of neurologists and 21% of ophthalmologists still recommend oral prednisone (1 mg/kg per day). Steroids are often prescribed for the wrong reason, including to improve final visual acuity or decrease the risk of MS. Disease modifying agents are sometimes prescribed outside of the official French recommendations. Conclusion. - The evidence-based guidelines are only partially followed by practitioners managing patients with acute optic neuritis. (c) 2008 Elsevier Masson SAS. Tous droits reserves.