Ординатура / Офтальмология / Английские материалы / Essentials in Ophthalmology Pediatric Ophthalmology Neuro-Ophthalmology Genetics_Lorenz, Borruat_2008
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XII Contents
8.9Visual Maps of Higher Visual Function: V4 . . . . . . . 126
8.10Visual Maps of Higher Visual Function: V3A, V3B and KO 126
8.11Segmenting Extrastriate Areas and MT+ into
|
Functional Subregions |
. . 127 |
8.12 |
Responses to Optic Flow |
. 128 |
8.13Disparity and Motion-in-
Depth Stimulation . . . . 129
8.14Interface Between Visual and Oculomotor
Systems . . . . . . . . . 129
8.15Parietal Lobe Maps
of Visuotopic Space . . . . 130
8.16Working Memory for Visual Stimuli . . . . . . . . . . 130
8.17Role of V1 in Visual Consciousness . . . . . . 132
8.18Summary . . . . . . . . 132
Chapter 9
Investigating Visual Function with Multifocal Visual Evoked Potentials
Michael B. Hoffmann
9.1Introduction . . . . . . . 139
9.2Multifocal Principle and Characteristics of Multifocal
VEPs . . . . . . . . . . . 140
9.2.1Basics – Multifocal Stimulation, First-
and Second-Order Kernels 140
9.2.2Stimulus Display for mfVEP Recordings . . . . . . . . 143
9.2.3Recording mfVEPs and Practical
Considerations . . . . . . 143
9.2.4Dependence
of mfVEPs on Visual Cortex
|
Morphology . . . . . . |
. 146 |
9.3 |
Assessment of mfVEPs . |
. 148 |
9.3.1Response Magnitude . . . 148
9.3.2Response Latency . . . . . 149
9.4mfVEP Investigations
|
of Diseases . . . . |
. . |
. |
. 151 |
9.4.1 |
mfVEP in Glaucoma |
. . |
. |
. 152 |
9.4.2mfVEP in Optic Neuritis . . 153
9.4.3 |
mfVEP in Albinism |
. . |
. |
. 154 |
9.5 |
Conclusion . . . |
. . . |
. |
. 157 |
Part III Retinal Disorders
Chapter 10
Autoimmune Retinopathies
Jennifer K. Hall, Nicholas J. Volpe
10.1Autoimmune Disease
Overview . . . . . . . . . . . . . . . . . 163
10.2Autoimmune Retinopathy Overview . . . . . . . . . . . . . . . . . 164
10.3Paraneoplastic
Retinopathies . . . . . . 164
10.3.1Cancer-Associated
Retinopathy . . . . . . . 164
10.3.1.1 |
Clinical Presentation |
. |
. |
. 166 |
10.3.1.2 |
Diagnostic Studies |
. . |
. |
. 166 |
10.3.1.3Pathophysiology . . . . . 166
10.3.1.4Treatment . . . . . . . . 168
10.3.2Melanoma-Associated Retinopathy . . . . . . . 168
10.3.2.1 |
Clinical Presentation |
. |
. |
. 168 |
10.3.2.2 |
Diagnostic Studies |
. . |
. |
. 168 |
10.3.2.3Pathophysiology . . . . . 169
10.3.2.4Treatment . . . . . . . . 169
10.3.3Bilateral Diffuse Uveal Melanocytic Proliferation . 169
10.3.3.1 |
Clinical Presentation |
. |
. |
. 170 |
10.3.3.2 |
Diagnostic Studies |
. . |
. |
. 170 |
10.3.3.3Pathophysiology . . . . . 170
10.3.3.4Treatment . . . . . . . . 171
10.4AutoimmuneRelated Retinopathy
and Optic Neuropathy . . . 171
10.5Acute Outer Retinopathies with Blind
Spot Enlargement . . . . 172
10.5.1Acute Idiopathic
Blind Spot Enlargement . . 173
10.5.1.1 |
Clinical Presentation |
. |
. |
. 173 |
10.5.1.2 |
Diagnostic Studies |
. . |
. |
. 173 |
10.5.1.3Pathophysiology . . . . . 173
10.5.1.4Treatment . . . . . . . . 176
10.5.2Multiple Evanescent White
|
Dot Syndrome . . |
. |
. |
. . 176 |
10.5.2.1 |
Clinical Presentation |
. |
. |
. 176 |
10.5.2.2 |
Diagnostic Studies |
. . |
. |
. 176 |
10.5.2.3Pathophysiology . . . . . 177
10.5.2.4Treatment . . . . . . . . 178
10.5.3Acute Zonal Occult Outer Retinopathy . . . . . . . 178
Contents XIII
10.5.3.1 |
Clinical Presentation |
. |
. |
. 178 |
10.5.3.2 |
Diagnostic Studies |
. . |
. |
. 178 |
10.5.3.3Pathophysiology . . . . . 179
10.5.3.4Treatment . . . . . . . . 179
10.5.3.5AZOOR Complex of Disease 179
10.6Summary . . . . . . . . 180
Chapter 11
Retinal Research: Application to Clinical Practice
Ludwig Aigner, Claudia Karl
11.1Introduction . . . . . . . 185
11.1.1Retinitis Pigmentosa . . . 185
11.1.2Age-Related Macular Degeneration . . . . . . 186
11.1.3Glaucoma . . . . . . . . 186
11.2 |
Cell Death in the Retina . . 186 |
11.2.1Major Characteristics
and Pathways of Apoptosis 187
11.2.1.1Caspase-Dependent
Apoptosis . . . . . . . . 187
11.2.1.2Caspase-Independent Apoptosis . . . . . . . . 188
11.3Therapeutic Strategies in Degenerative Retinal
Diseases . . . . . . . . . 189
11.3.1Strategies
for Neuroprotection . . . 189
11.3.1.1Animal Models in Retinal Degeneration Research . . . . 189
11.3.1.2Strategies
for Neuroprotection Interfering
with the Induction Phase
of Apoptosis . . . . . . . 190
11.3.1.3Strategies
for Neuroprotection Interfering with the Early
Phase of Apoptosis . . . . 191
11.3.1.4Strategies Using Neuroprotective Cytokines that Showed Effects in Other
Tissues . . . . . . . . . . 191
11.3.2Cell Therapy
for the Diseased Retina . . 192
11.3.2.1Cell Transplantation
in the Retina . . . . . . . 193
11.3.2.2Application of Transgenes or Genetically Engineered
Stem and Progenitor Cells 198
11.3.2.3Endogenous Cell
Replacement in the Retina 199
Part IV Systemic disease
Chapter 12
Chorioretinal Lesions in Infectious
Diseases of Neuroophthalmic Interest
Yan Guex-Crosier
12.1Introduction . . . . . . . 206
12.2 |
Ocular Zoonosis . . . . |
. 206 |
12.2.1 |
Ocular Toxoplasmosis . . |
. 206 |
12.2.1.1 |
Congenital Toxoplasmosis |
. 206 |
12.2.1.2Reactivation
of Toxoplasmosis
in Immunocompetent
Patients . . . . . . . . . 207
12.2.1.3Ophthalmic Toxoplasmosis
in AIDS Patients . . . . . . 209
12.2.1.4Neurologic Manifestation of Toxoplasmosis in AIDS
Patients . . . . . . . . . 209
12.2.1.5Radiologic Manifestation
of Toxoplasmosis in AIDS . 209
12.2.2Toxocariasis . . . . . . . 210 12.2.2.1 Introduction . . . . . . . 210 12.2.2.2 Ocular Manifestations . . . 210 12.2.2.3 Neurologic Manifestations 210
12.2.3Diseases Transmitted
by Ticks . . . . . . . . . 210
12.2.3.1Introduction . . . . . . . 210
12.2.3.2Tick-Borne Encephalitis . . 210
12.2.3.3Lyme Disease . . . . . . . 211
12.2.4 |
Cat Scratch Disease . . . . 214 |
12.2.4.1Introduction . . . . . . . 214
12.2.4.2Ocular
and Neuroophthalmologic Manifestations . . . . . . 214
12.2.4.3Neurologic Manifestations 215
12.2.4.4Therapy . . . . . . . . . 215
12.3Sexually Transmitted
Diseases . . . . . . . . . 215
12.3.1 Syphilis . . . . . . . . . 215
12.3.1.1Introduction . . . . . . . 215
12.3.1.2Ocular
and Neuroophthalmologic
Manifestations . . |
. |
. |
. |
. 215 |
12.3.1.3 Diagnostic Tests . |
. |
. |
. |
. 216 |
XIV Contents
12.3.1.4 Therapy . . . . . . . . . 216
12.3.2Human Immunodeficiency Virus (HIV)
|
and Ocular Infection |
. . . 216 |
||
12.3.2.1 Introduction . . |
. |
. |
. . . 216 |
|
12.3.2.2 |
HIV Retinopathy |
. |
. |
. . . 217 |
12.3.2.3 |
CMV Retinitis . . |
|
. |
. . . . 218 |
12.4Encephalopathies Due to Viral and Non-
Conventional Agents . . . 220
12.4.1Lymphocytic
Choriomeningitis Virus . . 220
12.4.2Creutzfeldt–Jakob
Disease . . . . . . . . . 220
12.4.3JC Virus
and Progressive Multifocal Leukoencephalopathy . . 221
12.4.4Herpetic Encephalopathy and Acute Retinal Necrosis
Syndrome . . . . . . . . 222
12.5Conclusion . . . . . . . . 222
Chapter 13
Giant Cell Arteritis
Aki Kawasaki
13.1Pathophysiology
of Giant Cell Arteritis . . . 227
13.1.1Epidemiology . . . . . . 227
13.1.2 |
Triggering Event . . . . . 228 |
13.1.3Tropism to Certain Vascular
Beds . . . . . . . . . . . 228
13.1.4Macrophage Recruitment
and Vascular Injury . . . . 229
13.1.5Systemic Inflammation . . 230
13.2Clinical (Non-Ophthalmic) Manifestations of GCA . . . 231
13.2.1 |
Natural History . . . . . . 231 |
13.2.2Systemic Signs
and Symptoms . . . . . . 231
13.2.3Headache
and Craniofacial Pain . . . 231
13.2.4Auditory Manifestations . . 232
13.2.5Neurologic Manifestations 232
13.2.6Occult GCA . . . . . . . . 232
13.3Visual Manifestations
of GCA . . . . . . |
. . |
. |
. 233 |
13.3.1 Transient Visual Loss |
. |
. |
. 233 |
13.3.2Anterior Ischemic Optic Neuropathy . . . . . . . 234
13.3.3Other Types
of Ischemic Visual Loss . . 235
13.3.4Diplopia . . . . . . . . . . . . . . . . . . 235
13.3.5Orbital Manifestations . . . 236
13.4 |
Clinical Subtypes of GCA . 236 |
13.4.1Systemic Inflammatory Syndrome . . . . . . . . 236
13.4.2 |
Cranial Arteritis . . . |
. |
. . 236 |
13.4.3 |
Large-Vessel Vasculitis |
. |
. 237 |
13.5Laboratory Investigations
in GCA . . . . . . . . . . 238
13.5.1Erythrocyte Sedimentation
Rate . . . . . . . . . . . 238
13.5.2 |
C-Reactive Protein |
. |
. |
. |
. 239 |
13.5.3 |
Thrombocytosis . |
. |
. |
. |
. 239 |
13.5.4Interleukin-6
and Other Cytokines . . . 239
13.5.5Anemia . . . . . . . . . 240
13.5.6Others . . . . . . . . . . 240
13.6 |
Diagnosis of GCA . . . . . 240 |
13.6.1Temporal Artery Biopsy . . . . 241
13.6.2American College
of Rheumatology Criteria . 241
13.6.3 |
Role of Ultrasound . . . . 243 |
13.6.4Other Non-Invasive Imaging
of the Cranial Arteries . . . 243
13.7Treatment and Prognosis
of GCA . . . . |
. |
. |
. |
. |
. |
. 244 |
13.7.1 Corticosteroids |
. |
. |
. |
. |
. |
. 244 |
13.7.1.1Starting Dose . . . . . . . 245
13.7.1.2Maintenance Dose . . . . 245
13.7.1.3 |
Tapering Regimen . . |
. |
. 245 |
13.7.1.4 |
Duration of Treatment . |
. |
. 245 |
13.7.2Visual Outcome
on Corticosteroids . . . . 245
13.7.3Methotrexate . . . . . . 246
13.7.4 Other Adjuvant Therapies . 246
13.7.5Treatment of Large-Vessel Involvement . . . . . . . 247
Part V Oculomotility
Chapter 14
Cerebral Control of Eye Movements
Charles Pierrot-Deseilligny
14.1Introduction . . . . . . . 254
14.2Brainstem . . . . . . . . 255
Contents XV
14.2.1Horizontal Eye Movements 255
14.2.1.1 |
Final Common Pathway |
. |
. 255 |
14.2.1.2 |
Premotor Structures |
|
|
|
and Afferent Pathways . |
|
. 257 |
14.2.2 |
Vertical Eye Movements |
. |
. 259 |
14.2.2.1 |
Final Common Pathway |
. |
. 259 |
14.2.2.2 |
Premotor Structures |
|
|
|
and Brainstem Afferents |
|
. 259 |
14.3 |
Suprareticular Structures |
|
. 261 |
14.3.1Cerebellum . . . . . . . . 261
14.3.2Cerebral Hemispheres . . . 262
14.4Abnormal Eye Movements 263
14.4.1Nystagmus . . . . . . . . 263
14.4.2Non-Nystagmic Abnormal
Eye Movements . . . . . . 264
Chapter 15
Chronic Progressive External
Ophthalmoplegia – A Common
Ocular Manifestation
of Mitochondrial Disorders
Marcus Deschauer, Stephan Zierz
15.1Introduction . . . . . . . 267
15.2 |
Clinical Features . . . . . 268 |
15.2.1Ophthalmoplegia
and Ptosis . . . . . . . . 268
15.2.2CPEO Plus: Multisystemic Involvement . . . . . . . 268
15.2.2.1 |
Muscle Impairment |
. . . |
. 268 |
15.2.2.2 |
Visual Impairment |
. . . |
. 268 |
15.2.2.3Specific CPEO Plus
Syndromes . . . . . . . . 268
15.3Genetics . . . . . . . . . 270
15.3.1General Mitochondrial
Genetics . . . . . . . . . 270
15.3.2Single Deletions of mtDNA 270
15.3.3Defects of Intergenomic Communication with Multiple Deletions
of mtDNA . . . . . . . . 271
15.3.4Point Mutations
of mtDNA . . . . . . |
. |
. 272 |
15.3.5 Coenzyme Q Deficiency |
. |
. 273 |
15.3.6Genotype–Phenotype Correlation . . . . . . . . 273
15.4Diagnostics . . . . . . . . 274
15.4.1Myohistological
Investigations . . . . . . 275
15.4.2Biochemical Investigations 275
15.4.3Molecular Genetic Investigations . . . . . . 275
15.5Treatment . . . . . . . . 276
15.5.1Pharmacological Therapy . 276
15.5.2 Symptomatic Treatment . 277
15.5.3Gene Therapy . . . . . . 277
15.6 |
Differential Diagnosis . . . 278 |
15.6.1Oculopharygeal Muscular Dystrophy . . . . . . . . 278
15.6.2 Myasthenic Syndromes . . 278
15.6.3Congenital Fibrosis
|
of the Extraocular Muscles |
279 |
15.6.4 |
Ocular Myositis . . . . . |
. 279 |
15.6.5 |
Endocrine |
|
|
Ophthalmopathy . . . . |
. 279 |
15.6.6Myotonic Dystrophy . . . 279
15.6.7Facioscapulohumeral
Muscular Dystrophy . . . . 279
15.6.8Congenital Myopathies . . 279
Chapter 16
Treatment of Specific Types
of Nystagmus
Marianne Dieterich
16.1Introduction . . . . . . . 284
16.2Peripheral Vestibular
and Ocular Motor Disorders 284
16.2.1Acute Peripheral Vestibulopathy, Vestibular
Neuritis . . . . . . . . . 284
16.2.1.1Etiology . . . . . . . . . 286
16.2.1.2Therapeutic
Recommendations . . . . 287
16.2.2Superior Oblique
Myokymia . . . . . . . . 288
16.2.2.1Etiology . . . . . . . . . 288
16.2.2.2Therapeutic
Recommendations . . . . 288
16.3Supranuclear Ocular Motor Disorders . . . . . . . . . 289
16.3.1Central Vestibular Disorders 289 16.3.1.1 Vestibular Syndromes
in the Sagittal (Pitch) Plane 289
16.3.2Central Ocular Motor
Disorders . . . . . . . . . 294
16.3.2.1Acquired Pendular
Nystagmus . . . . . . . . 294
16.3.2.2Opsoclonus and Ocular
Flutter . . . . . . . . . . 296
XVI Contents
Part VI Rehabilitation
Chapter 17
Rehabilitation
in Neuroophthalmology
Susanne Trauzettel-Klosinski
17.1Introduction . . . . . . . 301
17.2Psychophysics of Normal Reading . . . . . . . . . 302
17.3Diseases of the Visual Pathways and their
|
Functional Deficits . . . |
|
. 303 |
17.3.1 |
Optic Neuropathies . . |
. |
. 303 |
17.3.1.1 |
Central Scotomas . . . |
. |
. 303 |
17.3.1.2 |
Arcuate Scotomas: Nerve |
|
|
|
Fiber Bundle Defects . . |
|
. 305 |
17.3.1.3Ring Scotomas . . . . . . . . . . . . 305
17.3.1.4Constricted Fields . . . . . 305
17.3.1.5The Impact of Visual Field Defects on Reading
Performance . . . . . . . 305
17.3.2Optic Chiasmal Syndromes 307
17.3.3Suprachiasmatic Lesions
of the Visual Pathways . . . 307
17.3.3.1Hemianopic Reading
Disorder . . . . . . . . . 308
17.3.3.2Hemianopic Orientation Disorder . . . . . . . . . 310
17.3.4Cortical Visual Impairment 311
17.4Diagnostic Procedures
to Examine Reading Ability 311
17.5Rehabilitation Programs . . 312
17.5.1Visual Aids in Reading
Disorders . . . . . . . . . 312
17.5.2Visual and Other Aids in Spatial Orientation
Problems . . . . . . . . . 313
17.5.3Training . . . . . . . . . 314
17.5.3.1 Training for Patients with Circumscribed Scotomas in the Central
Field . . . . . . . . . . . 314
17.5.3.2Training for Patients with Homonymous Field
Defects . . . . . . . . . 315
17.5.4Counseling Regarding
Public Support . . . . . . . . . . . . 316
17.6Summary and Conclusions 316
Subject Index . . . . . . . . . 321
Contributors
Ludwig Aigner, Prof. Dr. |
François-Xavier Borruat, MD, PD, MER |
Klinik und Poliklinik für Neurologie |
Department of Neuro-Ophthalmology |
der Universität Regensburg |
Hôpital Ophtalmique Jules Gonin |
Im Bezirksklinikum |
Avenue de France 15 |
Universitätsstraße 84 |
CH-1004 Lausanne |
93053 Regensburg |
Switzerland |
Germany |
|
|
Marcus Deschauer, Priv.-Doz. Dr. |
Anthony C. Arnold, MD, Prof. |
Neurologische Klinik |
Neuro-Ophthalmology Division |
der Universität Halle-Wittenberg |
Director, UCLA Optic Neuropathy Center |
Ernst-Grube-Straße 40 |
Jules Stein Eye Institute |
06097 Halle/Saale |
UCLA Department of Ophthalmology |
Germany |
100 Stein Plaza |
|
Los Angeles, CA 90095-7005 |
Marianne Dieterich, Prof. Dr. |
USA |
Neurologische Klinik, Universität Mainz |
|
Langenbeckstraße 1 |
Edward J. Atkins, MD |
55101 Mainz |
Division of Neurology |
Germany |
University of Saskatchewan |
|
RUH Box 239 |
Marc Dinkin, MD |
103 Hospital Drive |
Brigham and Women’s Hospital |
Saskatoon, SK, S7N 0W8 |
75 Francis Street |
Canada |
Boston, MA 02115 |
Michelle Banks, MD |
USA |
|
|
100 Stein Plaza |
Mark W. Greenlee, Prof. Dr. |
Los Angeles, California |
Institut für Experimentelle Psychologie |
USA |
Universität Regensburg |
|
Universitätsstraße 31 |
Valérie Biousse, MD, Prof. |
93053 Regensburg |
Departments of Ophthalmology and Neurology |
Germany |
Emory University |
|
Neuro-ophthalmology Unit |
Stephan Grewe, Dr. |
Emory Eye Center |
Institut für Experimentelle Ophthalmologie |
1365-B Clifton Road, NE, Atlanta, Georgia 30322 |
Klinik und Poliklinik für Augenheilkunde |
USA |
Domagkstraße 15 |
|
48149 Münster |
|
Germany |
XVIII Contributors
Yan Guex-Crosier, MD, PD, MER
Ocular Immunology and Inflammation Unit Jules Gonin Eye Hospital
15 av. de France CH 1004 Lausanne Switzerland
Jennifer K. Hall, MD
Scheie Eye Institute
University of Pennsylvania Department
of Ophthalmology
51 North 39th Street
Philadelphia, Pennsylvania 19104
USA
Michael B. Hoffmann, Dr.
Universitäts-Augenklinik
Visual Processing Laboratory
Leipziger Straße 44
39120 Magdeburg
Germany
Claudia Karl, Dr.
Institut für Neurologie
Universität Regensburg
Germany
Aki Kawasaki, MD, MER
Department of Neuro-ophthalmology Hôpital Ophtalmique Jules Gonin Avenue de France 15
1004 Lausanne Switzerland
Birgit Lorenz, MD, FEBO, Prof.
Klinik und Poliklinik für Augenheilkunde Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
Friedrichstraße 18 35392 Gießen Germany
Tim D. Matthews, MBBS, FRCS, FRCOphth
Department of Ophthalmology
Selly Oak Hospital
Raddlebarn Rd
Birmingham B29 6 JD
UK
Nancy J. Newman, MD, Prof.
Departments of Ophthalmology Neurology, and Neurological surgery
Emory University, Neuro-ophthalmology Unit Emory Eye Center
1365-B Clifton Road, NE, Atlanta Georgia 30322 USA
Charles Pierrot-Deseilligny, MD, Prof.
Hôpital La Pitié-Salpêtrière 47-83, Boulevard de l'Hôpital 75651 Paris Cedex 13 France
Joseph F. Rizzo III, MD, Prof.
Massachussetts Eye and Ear Infirmary Department of Neuro-Ophthalmology 243 Charles Street, 9th FL
Boston, MA 02114 USA
Tobias Stupp, PD, Dr.
Institut für Experimentelle Ophthalmologie Klinik und Poliklinik für Augenheilkunde Domagkstraße 15
48149 Münster Germany
Solon Thanos, Prof. Dr.
Institut für Experimentelle Ophthalmologie Klinik und Poliklinik für Augenheilkunde Domagkstraße 15
48149 Münster Germany
Susanne Trauzettel-Klosinski, Prof. Dr.
Augenklinik der Universität Tübingen Schleichstraße 12–16
72076 Tübingen Germany
Peter U. Tse. Dr.
Institute für Experimentelle Psychologie der Universität Regensburg
93053 Regensburg Germany
Contributors XIX
Nicholas J. Volpe. MD, Prof. |
Stephan Zierz, Prof., Dr. |
Scheie Eye Institute |
Neurologische Universitätsklinik |
University of Pennsylvania Department |
Ernst-Grube-Straße 40 |
of Ophthalmology |
06120 Halle (Saale) |
51 North 39th Street |
Germany |
Philadelphia, Pennsylvania 19104 |
|
USA |
|
Marcela Votruba, MA, BM, BCh, FRCOphth, PhD |
|
School of Optometry & Vision Science |
|
Cardiff University |
|
Maindy Road |
|
Cathays |
|
Cardiff CF24 4LU |
|
UK |
|
Part I
Optic Nerve
Chapter 1 |
|
Optic Neuritis |
1 |
and Multiple Sclerosis |
Edward J. Atkins, Valérie Biousse, Nancy J. Newman
Core Messages
■Idiopathic optic neuritis, an isolated inflammatory optic neuropathy secondary to demyelination, is the most common cause of optic neuropathy in the young and is often the first sign of multiple sclerosis (MS).
■It is now possible to predict the risk of subsequent MS in selected patients with optic neuritis, allowing the anticipatory use of immunomodulatory agents to reduce the risk and severity of MS in those patients.
■A number of recent studies have clarified the natural history of optic neuritis, the largest being the Optic Neuritis Treatment Trial (ONTT).
■The ONTT confirmed that spontaneous visual recovery begins rapidly (within 3 weeks) in about 80% of patients and continues for up to 1 year; if at least some improvement does not occur within 5 weeks, the diagnosis of idiopathic optic neuritis should be reconsidered.
■The initial magnetic resonance imaging (MRI) helps to stratify the risk of MS. In the ONTT, the 10-year risk of MS in patients with at least one MRI T2 lesion was 56%, as compared to 22% in those with a normal baseline MRI. A normal MRI in combination with painless optic neuritis, severe optic nerve head edema, peripapillary hemorrhages, or a macular star defines a very low MS risk subgroup.
■In the ONTT, treatment with a lower dose of oral corticosteroids (1 mg/kg per day) was associated with an increased risk of recurrent optic neuritis, with a 41% chance of recurrence at 5 years among patients who received oral prednisone, versus 25% for those who received highdose intravenous methylprednisolone (1000 mg/day) or placebo.
■High-dose steroids hasten the rate, but not the final extent, of visual recovery in optic neuritis, and the decision to use this therapy should be individualized.
■Interferon beta-1a or beta-1b therapy should be considered in selected highrisk patients.