Optic neuritis is a condition in which the optic nerve becomes inflamed, causing temporary vision loss and pain. It can be triggered by an infection in a person with an autoimmune disorder. It can also be a sign of multiple sclerosis (MS). Optic neuritis can clear up on its own, though steroids are commonly used in the treatment of optic neuritis to help alleviate the inflammation.
It is common for patients with this condition to be treated initially with IV steroids. The effects of this treatment may last for only a few days, but it can expedite the recovery of vision. The IV steroid treatment may be followed by treatment with oral steroids.
The oral steroid prednisone may be used following a round of treatment with IV steroids in patients with optic neuritis. This course of treatment typically lasts two weeks and is used to help aid in the long-term vision recovery process.
Plasma Exchange Therapy
When steroids have proven ineffective, or when the vision loss is still present, some patients may be put on a plasma exchange therapy. Plasma exchange therapy is also known as plasmapheresis. It involves the removal of the patient’s plasma from his blood, and the blood, with other fluids added, is then returned to the patient. This is because the plasma contains the antibodies that can be causing problems for the patient in his recovery process.This treatment is also used with patients with other autoimmune disorders.
Optic Neuritis and MS
Dr. Brian Loftus, citing published studies regarding optic neuritis treatment in patients with MS stated that, “Fortunately, the patients in this study were followed for many years and there is some information available as to the future of patients who have an attack of optic neuritis. For those who have an MRI with 3 or more lesions felt to be compatible with multiple sclerosis, then at five years about half of the patients definitely had multiple sclerosis. At ten years, the chance of having multiple sclerosis was about 60 percent.” He went on to state that, of those with an abnormal MRI with only 1 lesion, about one-third developed MS more slowly in five years, but the rate rose to 50 percent in 10 years.
He explained that the study showed how the use of IV steroids was of more benefit than the use of oral steroids alone when it came to vision results over the long term. Patients who have optic neuritis and who are at risk of developing MS (based upon results of MRI testing) may be put on injectable prescription drugs to help prevent the MS. Two of these drugs are interferon beta-1a and interferon beta-1b.
Patients who only experience one bout of optic neuritis tend to recover their vision over time. The use of steroids for treatment of optic neuritis can expedite vision recovery. Patients showing lesions in MRI test results may be at risk for developing multiple sclerosis and will need further treatment to help prevent it.
Mayo Clinic Staff. “Optic Neuritis” https://www.mayoclinic.com/health/optic-neuritis/DS00882
Loftus, Brian D., M.D. “Optic Neuritis” https://www.bellaireneurology.com/multiple_sclerosis/ms_optic.html
Muscular Dystrophy Association. “Facts about Plasmapheresis” https://www.mdausa.org/publications/fa-plasmaph.html