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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

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