PMID- 27472185
OWN - NLM
STAT- MEDLINE
DCOM- 20170901
LR  - 20180116
IS  - 1536-5166 (Electronic)
IS  - 1070-8022 (Linking)
VI  - 36
IP  - 4
DP  - 2016 Dec
TI  - 20/40 or Better Visual Acuity After Optic Neuritis: Not as Good as We Once 
      Thought?
PG  - 369-376
AB  - BACKGROUND: Although patients with acute optic neuritis (ON) recover 
      high-contrast visual acuity (HCVA) to 20/40 or better in 95% of affected eyes, 
      patients with a history of ON continue to note subjective abnormalities of 
      vision. Furthermore, substantial and permanent thinning of the retinal nerve 
      fiber layer (RNFL) and the ganglion cell layer (GCL) is now known to occur early 
      in the course of ON. We measured vision-specific quality of life (QOL) in 
      patients with a history of acute ON and recovery of VA to 20/40 or better in 
      their affected eyes to determine how these QOL scores relate to RNFL and GCL 
      thickness and low-contrast letter acuity (LCLA) across the spectrum of visual 
      recovery. METHODS: Data from an ongoing collaborative study of visual outcomes in 
      multiple sclerosis and ON were analyzed for this cross-sectional observational 
      cohort. Patients and disease-free control participants completed the 25-Item 
      National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and 10-Item 
      Neuro-Ophthalmic Supplement to the NEI-VFQ-25, as well as VA and LCLA testing for 
      each eye separately and binocularly. Optical coherence tomography measures for 
      each eye included peripapillary RNFL thickness and macular GCL + inner plexiform 
      layer (GCL + IPL) thickness. RESULTS: Patients with a history of acute ON and 
      recovery to 20/40 or better VA (n = 113) had significantly reduced scores for the 
      NEI-VFQ-25 (83.7 +/- 15.4) and 10-Item Neuro-Ophthalmic Supplement (74.6 +/- 17.4) 
      compared with disease-free controls (98.2 +/- 2.1 and 96.4 +/- 5.2, P < 0.001, linear 
      regression models, accounting for age and within-patient, intereye correlations). 
      Most patients with 20/40 or better visual recovery (98/112, 88%) had monocular 
      HCVA in their affected eye of 20/20 or better. Although patients with 20/50 or 
      worse HCVA recovery demonstrated the worst performance on low-contrast acuity, 
      affected eye RNFL and GCL + IPL thickness, and QOL scales, these measures were 
      also significantly reduced among those with 20/40 or better HCVA recovery 
      compared with controls. CONCLUSIONS: Patients with a history of ON and "good" 
      visual recovery, defined in the literature as 20/40 or better HCVA, are left with 
      clinically meaningful reductions in vision-specific QOL. Such patient-observed 
      deficits reflect the underlying significant degrees of retinal axonal and 
      neuronal loss and visual dysfunction that are now known to characterize ON even 
      in the setting of maximal HCVA recovery. There remains an unmet therapeutic need 
      for patients with ON.
FAU - Sabadia, Sakinah B
AU  - Sabadia SB
AD  - Departments of Neurology (SBS, RCN, KN, SLG, LJB), Population Health (LJB) and 
      Ophthalmology (SLG, LJB), New York University School of Medicine, New York, New 
      York; Department of Neurology (KMG, JAW), University of Pennsylvania School of 
      Medicine, Philadelphia, Pennsylvania; Department of Neurology (PAC), Johns 
      Hopkins University School of Medicine, Baltimore, Maryland; and Department of 
      Neurology (EMF), University of Texas Southwestern Medical Center, Dallas, Texas.
FAU - Nolan, Rachel C
AU  - Nolan RC
FAU - Galetta, Kristin M
AU  - Galetta KM
FAU - Narayana, Kannan M
AU  - Narayana KM
FAU - Wilson, James A
AU  - Wilson JA
FAU - Calabresi, Peter A
AU  - Calabresi PA
FAU - Frohman, Elliot M
AU  - Frohman EM
FAU - Galetta, Steven L
AU  - Galetta SL
FAU - Balcer, Laura J
AU  - Balcer LJ
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Neuroophthalmol
JT  - Journal of neuro-ophthalmology : the official journal of the North American 
      Neuro-Ophthalmology Society
JID - 9431308
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Cross-Sectional Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nerve Fibers/*pathology
MH  - Optic Neuritis/diagnosis/*physiopathology
MH  - *Recovery of Function
MH  - Retinal Ganglion Cells/*pathology
MH  - Time Factors
MH  - Tomography, Optical Coherence/*methods
MH  - *Visual Acuity
EDAT- 2016/07/30 06:00
MHDA- 2017/09/02 06:00
CRDT- 2016/07/30 06:00
PHST- 2016/07/30 06:00 [pubmed]
PHST- 2017/09/02 06:00 [medline]
PHST- 2016/07/30 06:00 [entrez]
AID - 10.1097/WNO.0000000000000421 [doi]
PST - ppublish
SO  - J Neuroophthalmol. 2016 Dec;36(4):369-376. doi: 10.1097/WNO.0000000000000421.