Disease Description (Causes and Symptoms)
- Definition: Optic neuritis is a condition in which inflammation develops in the optic nerve, causing decreased vision, visual field disturbances, reduced color contrast (colors appear faded), and pain when moving the eyes.
- Main causes and pathophysiology: The cause is often unknown, but possible causes include viral or bacterial infections, autoimmune diseases (e.g., multiple sclerosis [MS] and anti-AQP4- or MOG-associated diseases), infections such as tuberculosis and syphilis, medications, and inflammatory diseases. When inflammation damages the myelin sheath of the optic nerve, the speed of impulse conduction slows and vision deteriorates.
- Main symptoms: Sudden decreased vision in one or both eyes (usually progressing over several days), pain around the eye (especially worsening when moving the eye), reduced color perception (weakening of red), reduced brightness and contrast, and visual field defects (such as a central scotoma).
Treatment Methods
- Acute treatment (standard): High-dose intravenous steroids are the standard initial treatment (e.g., methylprednisolone 1 g IV/day × 3–5 days). If necessary, treatment is followed by a short-term switch to oral steroids and tapering. However, caution is required because low-dose oral steroids alone are associated with an increased risk of relapse.
- Steroid-refractory/severe cases: Plasma exchange (PLEX) may be considered when there is no response to high-dose steroids or when vision loss is very severe.
- Long-term treatment according to the underlying cause: If an autoimmune cause such as anti-AQP4-positive NMOSD or MOG-associated disease is confirmed, long-term immunosuppressive treatment (such as rituximab, azathioprine, or mycophenolate) may be needed to prevent relapse.
- Supportive tests and treatment: Correction of nutritional causes such as vitamin B12 deficiency, pain-control medications, and so on.
- Lifestyle management and precautions: Get sufficient rest, stop smoking (smoking is a factor that increases the risk of MS and worsens its prognosis), and monitor for side effects such as infection, diabetes, and osteoporosis when receiving steroids.
Checkpoints Before an Outpatient Visit (Including Preparation Items and Example Questions)
- Items to prepare (recommended to bring)
- A list of currently used medications (including prescription drugs, over-the-counter drugs, and supplements)
- Past medical history and surgical records (especially MS, autoimmune diseases, and a history of infections)
- Results of previous tests (brain/orbital MRI, visual field tests, fundus photographs, blood test results, etc.)
- The time of symptom onset and its course (when it began and how quickly it progressed), whether it affects one or both eyes, and a record of the presence and nature of pain
- Information about the possibility of pregnancy (for women) and drug allergies
- Information to tell the doctor in advance during the visit
- The date symptoms began and how they have changed (whether they have improved or worsened)
- Recent infections and vaccination history
- Previous neurological symptoms (sensory abnormalities, gait disturbance, paralysis, etc.)
Examples of General Questions to Ask the Doctor
- What is the exact cause of this condition? What additional tests are needed?
- What are the benefits and side effects of the recommended treatment (such as steroids)?
- What is the expected recovery period and final prognosis? How likely is it that my vision will fully recover?
- How likely is multiple sclerosis (MS)? What tests are needed to determine this?
- What precautions should I take in daily life (driving, work, exercise, pregnancy, etc.)?
Examples of Condition-Specific Questions
- A lesion is visible on brain and orbital MRI. In this case, are tests for multiple sclerosis or NMOSD (anti-AQP4 and MOG antibody tests) needed?
- Intravenous steroid treatment is recommended, but I have an underlying condition that may prevent me from using steroids (diabetes, infection, osteoporosis, etc.). When should alternative treatments (e.g., PLEX) be considered?
Additional information: Because the results of tests (MRI, visual evoked potential (VEP), fundus examination, OCT, and visual field test) and antibody tests (AQP4 and MOG) influence the risk of future relapse and decisions about long-term treatment, it is important to undergo them as early as possible and discuss the results with the treating doctor.