High-Contrast Visual Acuity Predicts Multiple Sclerosis Optic Neuritis Outcomes

In patients with idiopathic or MS-associated optic neuritis who have a baseline high-contrast visual acuity better than count fingers, long-term outcomes are usually good.

High-contrast visual acuity (HCVA) at baseline can help predict visual acuity outcomes for patients with multiple sclerosis (ms)-associated or idiopathic optic neuritis (ON), according to findings published in the Journal of Neuro-Ophthalmology. In general, patients with better than count fingers baseline HCVA had good long-term visual outcomes, researchers report.

The retrospective, longitudinal study evaluated predictors of long-term high-contrast visual acuity in a modern, real-world population of patients with ON and compared them with previously published Optic Neuritis Treatment Trial (ONTT; ClinicalTrials.gov Identifier: NCT00000146) models. The study included 118 patients (mean age, 39 years; 91 women) with 135 episodes of idiopathic or MS-associated ON diagnosed within 30 days of onset. HCVA at 6 to 18 months was the primary outcome measure.

Among the cohort, 101 (75.9%) reported pain, 33 (24.4%) had disc edema, 8 (5.9%) had a viral prodrome, 66 (48.9%) had MS, and 62 (46.6%) were treated with glucocorticoids. The median time between symptom onset and diagnosis was 6 days.

Women and patients with pain trended toward an association with better HCVA outcome.

At baseline the median high-contrast visual acuities were 20/50. At 6 to 18 months, they were 20/20. The investigators report that 62 (45.9%) patients had high-contrast visual acuities better than 20/40 at baseline and 117 (86.7%) had better than 20/40 at 6 to 18 months.

Only baseline acuities (P =.027) were associated with long-term HCVA, according to the researchers. Compared with published ONTT models, regression coefficients were similar and within the 95% confidence interval of coefficients.

The researchers explain that the study’s findings regarding long-term high-contrast visual acuities predictors are consistent with their previous research using ONTT data, highlighting their validity for use clinically.

“Although baseline HCVA was the only significant predictor of long-term HCVA among patients with baseline HCVA better than CF, trends among other potentially important variables were observed,” the study authors note. “Women and patients with pain trended toward an association with better HCVA outcome.”

Study limitations include the lack of inclusion of ON recurrences; and the lack of randomization of patients.


Jarocki A, Benard-Seguin E, Gonzalez L, et al. Predictors of long-term visual acuity in a modern cohort of patients with acute idiopathic and multiple sclerosis–associated optic neuritis. J Neuro Ophthalmol. Published online May 18, 2023. doi:10.1097/WNO.0000000000001870