We read with great interest the article entitled “Visual Outcomes in Pediatric Optic Neuritis” by Wan and associates, which describes visual outcomes and potential risk factors for poor visual recovery after a first episode of optic neuritis in children. There is scanty data regarding optic neuritis in children and this study certainly provides very valuable inputs, especially as the follow-up was carried out at 2 defined time intervals of 3 months and 1 year after the initial attack. This provides us with a timeline for the visual recovery.
The authors have mentioned that the only risk factor for poor visual recovery was found to be poor recovery of vision at 3 months and that other variables such as sex, baseline vision, laterality, treatment, or underlying diagnosis did not predict poor visual outcome. However, there is no mention of any racial difference seen in visual outcome. A recent analysis of the ONTT (Optic Neuritis Treatment Trial) data showed that race/ethnicity is associated with long-term contrast sensitivity and visual acuity outcomes after optic neuritis, with a worse outcome in patients belonging to the African-American and other diverse ethnic groups. Another study by Phillips and associates also demonstrated similar results and showed that a higher percentage of African-American patients went on to develop multiple sclerosis and neuromyelitis optica. This is of particular interest to us in the Indian subcontinent, since studies from India have also shown differences from the pattern reported in the ONTT, with a higher rate of bilaterality, poorer visual outcomes, and a lower rate of multiple sclerosis.
We see a large number of patients in the pediatric age group with optic neuritis in our practice and feel that there may be significant differences from the cohort described in this study. Our hitherto unpublished data of 34 children presenting with optic neuritis with a mean age of 12.38 years (range 5–15 years) show that 65% had bilateral involvement, as compared to 41% in the current study; 26.4% had papillitis, as compared to 67% in the current study; and none went on to develop multiple sclerosis, as compared to 39% in the current study. A majority, however, recovered good visual acuity (>20/40) at last follow-up, though follow-up intervals varied from patient to patient.
Also, the authors mention in the initial data that 9 patients (4%) were not treated; it would be interesting to know if visual outcomes varied in these patients and the reason for not treating, and also if these children had any underlying systemic diagnoses. This subset is of particular interest to us, since in our practice a significant proportion of patients may refuse or be unable to receive treatment for socioeconomic reasons.