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Management of Optic Neuritis in Canada: Survey of Ophthalmologists and Neurologists

Published online by Cambridge University Press:  02 December 2014

Edward J. Atkins ,
Carolyn D. Drews-Botsch ,
Nancy J. Newman ,
Olivier Calvetti ,
Seegar Swanson  and
Valérie Biousse
Edward J. Atkins
Affiliation:
Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada
Carolyn D. Drews-Botsch
Affiliation:
Rollins School of Public Health, Emory University
Nancy J. Newman
Affiliation:
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA Departments of Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
Olivier Calvetti
Affiliation:
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
Seegar Swanson
Affiliation:
Rollins School of Public Health, Emory University
Valérie Biousse
Affiliation:
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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abstract

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Background:

Acute isolated optic neuritis is often the first manifestation of multiple sclerosis (MS), and its management remains controversial. Over the past decade, with the advent of new disease-modifying agents, management of isolated optic neuritis has become more complicated.

Objectives:

To evaluate the current practice patterns of Canadian ophthalmologists and neurologists in the management of acute optic neuritis, and to evaluate the impact of recently published randomized clinical trials.

Design:

Mail survey.

Methods:

All practicing ophthalmologists and neurologists in Canada were mailed a survey evaluating the management of isolated acute optic neuritis and familiarity with recent clinical trials. Surveys for 1158 were mailed, and completed surveys were collected anonymously through a datafax system. Second and third mailings were sent to non-respondents 6 and 12 weeks later.

Results:

The final response rate was 34.5%. Although many acute optic neuritis patients initially present to ophthalmologists, neurologists are the physicians primarily managing these patients. Ordering magnetic resonance imaging, and treating with high dose intravenous steroids has become the standard of care. However, 15% of physicians (14% of ophthalmologists and 16% of neurologists) continue to prescribe low dose oral steroids, and steroids are being given for reasons other than to shorten the duration of visual symptoms by 73% of ophthalmologists and 50% of neurologists. More neurologists than ophthalmologists are familiar with recent clinical trials involving disease-modifying agents.

Conclusion:

Although the management of acute optic neuritis has been evaluated in large clinical trials that were published in major international journals, some ophthalmologists and neurologists are not following evidence-based recommendations.

résumé:

<span class='bold'>RÉSUMÉ:</span> <span class='bold'> <span class='italic'>Contexte:</span></span>

La névrite optique aiguë isolée est souvent la première manifestation de la sclérose en plaques (SEP) et son traitement demeure controversé. Au cours des dix dernières années, le traitement de la névrite optique isolée s’est ompliqué à cause de l’apparition sur le marché de nouveaux agents qui modifient l’évolution de la maladie.

<span class='bold'> <span class='italic'>Objectifs:</span></span>

Le but de cette étude était d’évaluer les habitudes de pratique actuelles des ophtalmologistes et des neurologues canadiens en ce qui concerne le traitement de la névrite optique aiguë et d’évaluer l’impact des essais cliniques randomisés publiés récemment.

<span class='bold'> <span class='italic'>Plan d’étude:</span></span>

Il s’agit d’une enquête postale

<span class='bold'> <span class='italic'>Méthodes:</span></span>

Un questionnaire portant sur le traitement de la névrite optique aiguë isolée et sur la familiarité avec les essais cliniques récents a été posté à tous les ophtalmologistes et neurologues du Canada.Mille cent cinquante–huit questionnaires ont été postés et les réponses ont été recueillies anonymement au moyen d’un système datafax. Un deuxième et un troisième envoi ont été faits aux non–répondeurs 6 et 12 semaines plus tard.

<span class='bold'> <span class='italic'>Résultats:</span></span>

Le taux de réponse final a été de 34,5%. Bien que plusieurs patients atteints de névrite optique aiguë consultent initialement un ophtalmologiste, ce sont principalement les neurologues qui traitent ces patients. On procède à une imagerie par résonance magnétique et le traitement standard actuel est l’administration intraveineuse de stéroïdes à haute dose. Cependant, 15% des médecins (14% des ophtalmologistes et 16% des neurologues) continuent à prescrire des stéroïdes à faible dose par voie orale et lesstéroïdes sont prescrits pour d’autres raisons que pour diminuer la durée des symptômes visuels par 73% des ophtalmologistes et 50% des neurologues. Plus de neurologues que d’ophtalmologistes connaissent les essais cliniques récents sur les agents modifiant l’évolution de la maladie.

<span class='bold'> <span class='italic'>Conclusion:</span></span>

Bien que le traitement de la névrite optique aiguë ait été évalué par des essais cliniques de grande envergure, publiés dans des revues internationales importantes, certains ophtalmologistes et neurologues ne suivent pas les recommandations de médecine factuelle.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 2 , May 2008 , pp. 179 - 184
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Atkins, EJ, Biousse, V, Newman, NJ. The natural history of optic neuritis. Rev Neurol Dis. 2006; 3:45–55.Google ScholarPubMed
2. Beck, RW, Cleary, PA, Anderson, MM Jr, Keltner, JL, Shults, WT, Kaufman, DI, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992; 326:581–8.CrossRefGoogle ScholarPubMed
3. Beck, RW, Cleary, PA, Trobe, JD, Kaufman, DI, Kupersmith, MJ, Paty, DW, et al. The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. The Optic Neuritis Study Group. N Engl J Med. 1993; 329:1764–9.CrossRefGoogle ScholarPubMed
4. Rolak, LA, Beck, RW, Paty, DW, Tourtellotte, WW, Whitaker, JN, Rudick, RA, Optic Neuritis Study Group. Cerebrospinal fluid in acute optic neuritis: experience of the optic neuritis treatment trial. Neurology. 1996; 46:368–72.CrossRefGoogle Scholar
5. Jacobs, LD, Beck, RW, Simon, JH, Kinkel, RP, Brownscheidle, CM, Murray, TJ, et al. Intramuscular interferon beta-la therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000; 343:898–904.CrossRefGoogle Scholar
6. CHAMPS Study Group. Interferon β-1a for optic neuritis patients at high-risk for multiple sclerosis. Am J Ophthalmol. 2001; 132:463–71.CrossRefGoogle Scholar
7. Beck, RW, Chandler, DL, Cole, SR, Simon, JH, Jacobs, LD, and the CHAMPS Study Group. Interferon β-1a for early multiple sclerosis: CHAMPS trial subgroup analyses. Ann Neurol. 2002; 51:481–90.CrossRefGoogle ScholarPubMed
8. Comi, G, Filippi, M, Barkhof, F, Durelli, L, Edan, G, Fernandez, O, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study (ETOMS). Lancet. 2001; 357:1576–82.CrossRefGoogle Scholar
9. Kappos, L, Polman, C, Freedman, M, Edan, G, Hartung, H, Miller, D, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006; 67:1242–9.CrossRefGoogle Scholar
10. Brex, P, Ciccarelli, O, O’Riordan, J, Sailer, M, Thompson, A, Miller, D. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med. 2002; 346:156–64.CrossRefGoogle ScholarPubMed
11. Soderstrom, M, Ya Ping, J, Hillert, J, Link, H. Optic neuritis, prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998; 50:708–14.CrossRefGoogle ScholarPubMed
12. Ghezzi, A, Martinelli, V, Torri, V, Zaffaroni, M, Rodegher, M, Comi, G, et al. Long-term follow-up of isolated optic neuritis: the risk of developing multiple sclerosis, its outcome, and the prognostic role of paraclinical tests. J Neurol. 1999; 246:770–5.CrossRefGoogle ScholarPubMed
13. Kaufman, DI, Trobe, JD, Eggenberger, ER, Whitaker, JN. Practice parameter: the role of corticosteroids in the management of acute monosymptomatic optic neuritis. Neurology. 2000; 54: 2039–44.CrossRefGoogle ScholarPubMed
14. Balcer, L. Optic neuritis. New Engl J Med. 2006; 354:1273–80.CrossRefGoogle ScholarPubMed
15. Frohman, E, Frohman, T, Zee, D, McColl, R, Galetta, S. The neuro-ophthalmology of multiple sclerosis. Lancet Neurol. 2005; 4: 111–21.CrossRefGoogle ScholarPubMed
16. Miller, D, Barkhof, F, Montalban, X, Thompson, A, Filippi, M. Clinically isolated syndromes suggestive of multiple sclerosis, part II: natural history, pathogenesis, diagnosis, and prognosis. Lancet Neurol. 2005; 4:281–8.CrossRefGoogle Scholar
17. Miller, D, Barkhof, F, Montalban, X, Thompson, A, Filippi, M. Clinically isolated syndromes suggestive of multiple sclerosis, part II: non-conventional MRI, recovery processes, and management. Lancet Neurol. 2005; 4:341–8.CrossRefGoogle Scholar
18. Arnold, AC. Evolving management of optic neuritis and multiple sclerosis. Am J Ophthalmol. 2005; 139:1101–8.CrossRefGoogle ScholarPubMed
19. Trobe, JD, Sieving, PC, Guire, KE, Fendrick, AM. The impact of the optic neuritis treatment trial on the practices of ophthalmologists and neurologists. Ophthalmology. 1999; 106: 2047–53.CrossRefGoogle ScholarPubMed
20. Ghosh, A, Kelly, S, Mathews, J, Cooper, PN, MacDermott, N. . J Neurol Neurosurg Psychiatry. 2002; 72:119–21.CrossRefGoogle Scholar
21. CHAMPIONS Study Group. IM interferon β-la delays definite multiple sclerosis 5 years after a first demyelinating event. Neurology. 2006; 66:678–84.CrossRefGoogle Scholar
22. Hikmet, N, Chen, S. An investigation into low survey response rates of information technology users in health care organizations. Int J Med Inform. 2003; 72:29–34.CrossRefGoogle ScholarPubMed
23. Cole, SR, Beck, RW, Moke, PS, Kaufman, DI, Tourtellotte, WW. The predictive value of CSF oligoclonal banding for MS 5 years after optic neuritis. Optic Neuritis Study Group. Neurology. 1998; 51:885–7.Google ScholarPubMed