Notwithstanding the cautionary comments of Silberberg,1 the conclusion that high-dose intravenous methylprednisolone followed by a course of oral prednisolone after a bout of acute optic neuritis will reduce the rate of development of multiple sclerosis (MS) over a 2-year period (in patients with white-matter lesions on magnetic resonance imaging) was both exciting and unexpected.2 To those who concur, those data will immediately change the existing management of optic neuritis. The 1-year results of the Optic Neuritis Treatment Trial (ONTT) indicated that intravenous corticosteroids would hasten visual recovery but not change the ultimate visual outcome. In cases of "typical" optic neuritis, neuroimaging and further blood tests were deemed unnecessary.3 Basedon the 2-year follow-up data, magnetic resonance imaging is suggested in all patients, with subsequent treatment of selected patients.
The 2-year results of the ONTT have been known to the investigators of the study (and available for dissemination) since
Slavin ML, Burde RM. Prepublication Blackout in the Optic Neuritis Treatment Trial. Arch Ophthalmol. 1994;112(5):581. doi:10.1001/archopht.1994.01090170025010
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