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Abstract Details

Predicting Optic Neuritis Outcomes
Neuro-ophthalmology/Neuro-otology
S32 - Neuro-ophthalmology/Neuro-otology (3:54 PM-4:06 PM)
003

To develop prediction models of corticosteroid treatment benefit at the individual level for patients with acute demyelinating optic neuritis (ON).

Shared decision making is not routinely occurring for ON. One barrier to shared decision making is that providers do not have information that considers individual characteristics and how those characteristics influence recovery. Personalizing clinical trial information addresses this barrier. No tools exist that allow clinicians to provide ON patients with personalized information regarding predicted visual recovery and predicted short term benefit with corticosteroids.
Using data from the Optic Neuritis Treatment Trial, multivariable linear regression models were built to predict visual acuity (VA) at one year. Secondary outcomes were one-year contrast sensitivity (CS), and VA and CS at 15 and 30 days. Independent variables included age, sex, race, multiple sclerosis history, fellow eye ON episodes, vision symptoms (days), pain, optic disc swelling, viral illness, treatment group (intravenous [IV] corticosteroid, oral corticosteroid, placebo) and baseline VA or CS. 

410 (90.1%) subjects had 1-year outcomes. Median VA improved from 20/66 at enrollment to 20/17 at 1-year. Of the 11 predictors assessed, only baseline VA was associated with VA at 1 year. At 15 days, both baseline VA and treatment status predicted VA. However, the difference of medians between treatment status was small for the average subject (20/18 [95% CI: 20/17, 20/19] IV corticosteroids versus 20/23 [95% CI: 20/21, 20/26] placebo) and there was no evidence of treatment benefit for subjects with light perception or no light perception VA at baseline.
The only predictor of long-term VA was severity of baseline vision loss. Early benefits with IV corticosteroid treatment were limited to patients with baseline vision better than light perception. However, the early and temporary benefit of IV corticosteroids is of questionable clinical significance and should be weighed against the potential harms. 
Authors/Disclosures
Lindsey B. DeLott, MD (Kellogg Eye Center, University of Michigan)
PRESENTER 		Dr. DeLott has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for argenx. The institution of Dr. DeLott has received research support from National Institutes of Health. The institution of Dr. DeLott has received research support from Myasthenia Gravis Foundation of America. The institution of Dr. DeLott has received research support from Research to Prevent Blindness.
James F. Burke, MD (Ohio State Wexner Medical Center) Dr. Burke has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association/Circulation: Cardiovascular quality and outcomes. The institution of Dr. Burke has received research support from Genentech Foundation. The institution of Dr. Burke has received research support from NIH.
No disclosure on file
Fiona E. Costello, MD (Fiona Costello Professional Corporation) Dr. Costello has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Costello has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Costello has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Costello has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Costello has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Accure Therapeutics. Dr. Costello has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for the Sumaira Foundation.
Wayne T. Cornblath, MD, FAAN Dr. Cornblath has nothing to disclose.
Jonathan D. Trobe, MD, FAAN (University of Michigan) No disclosure on file
No disclosure on file
Kevin A. Kerber, MD (Ohio State University Department of Neurology) Dr. Kerber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for 好色先生. Dr. Kerber has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for McBride Hall Attorneys . The institution of Dr. Kerber has received research support from National Institutes of Health. Dr. Kerber has received publishing royalties from a publication relating to health care.