Steroids Not Indicated for Every Patient with MS-Related Optic Neuritis

Despite its side effects, intravenous methylprednisolone is still used by many ophthalmologists and neurologists to treat multiple sclerosis (MS)-related demyelinating optic neuritis, according to researchers. However, findings published in Clinical Ophthalmology suggest that steroid therapy only should be considered on an individual basis and not as a routine treatment for each patient.

Demyelinating retrobulbar optic neuritis is closely linked to MS and may be the first sign of the disease. Currently, treatment with 1 g intravenous methylprednisolone for 3 days is recommended only for patients with severe or bilateral vision loss or those with 2 or more white matter lesions seen via MRI, according to investigators, yet it is prescribed more frequently. 

Researchers compared the structure and function of the retina and the optic nerve in patients with a history of MS-related demyelinating retrobulbar optic neuritis. The 32 eyes of 32 patients with a past single episode of MS-related demyelinating retrobulbar optic neuritis were divided into 2 groups: S(+) consisting of 16 patients who were treated with intravenous methylprednisolone at a dose of 1g/day for 3 days during the acute stage of optic neuritis, and S(-) consisting of 16 patients who did not receive any treatment.

Researchers performed distance best-corrected visual acuity (DBCVA), slit-lamp examination of the anterior and posterior segment of the eye, visual field analysis, macular thickness in the foveal (RT1) and parafoveal region (RT2), peripapillary retinal nerve fiber layer thickness (RNFL) in the temporal, superior, nasal, and inferior quadrants, assessment of the bioelectrical function of the visual pathway with an emphasis on the optic nerve – pattern visual evoked potentials (PVEP) and of macular ganglion cells and cone photoreceptors – pattern electroretinogram (PERG).

They found no statistically significant differences between the groups regarding DBCVA, mean deviation of visual field macular (RT1, RT2), RNFL thickness in the temporal, superior, nasal, and inferior quadrants, and bioelectrical function (PVEP, PERG).

“The results of our study indicate that there is no statistically significant difference in the function and structure of the retina and the optic nerve in long-term observation of eyes with a history of demyelinating ON treated or not treated with intravenous steroids,” explains the study. “Therefore, the application of steroid therapy should be considered on an individual basis and not as a routine treatment for all patients.”

Reference

Nowacka B, Lubiński W. Comparison of the structure and function of the retina and the optic nerve in patients with a history of multiple sclerosis-related demyelinating retrobulbar optic neuritis treated and not treated with systemic steroid therapy. Clin Ophthalmol. 2021;15:2253-2261. doi:10.2147/OPTH.S309975