J D Trobe1, P C Sieving, K E Guire, A M Fendrick. 1. Department of Ophthalmology, W.K. Kellogg Eye Center, School of Medicine, University of Michigan, Ann Arbor 48105, USA. jdt@umich.edu
Abstract
OBJECTIVE: To determine whether the Optic Neuritis Treatment Trial (ONTT) results have altered the practice patterns of ophthalmologists and neurologists. DESIGN: Mail survey. PARTICIPANTS: A random sample of 987 ophthalmologists and 900 neurologists practicing in the United States were mailed a questionnaire that inquired into decision-making with regard to management of optic neuritis before and after the publication of the ONTT results. MAIN OUTCOME MEASURES: Responses received from 202 ophthalmologists and 244 neurologists, a response rate of 47%. RESULTS: Following the ONTT reports, nearly all ophthalmologists and neurologists have reduced their use of oral prednisone alone, substituting a regimen that includes intravenous methylprednisolone. A large proportion of practitioners in both specialties mistakenly believe that intravenous methylprednisolone treatment improves final visual outcome. Only 7% of neurologists and 36% of ophthalmologists (P = 0.0001) are adhering to the ONTT suggestion to use magnetic resonance imaging as a basis for initiating treatment. CONCLUSIONS: The ONTT has led to a dramatic reduction in the use of oral prednisone without a preceding course of intravenous methylprednisolone in the treatment of acute optic neuritis. Ophthalmologists and neurologists have changed some of their practices without fully understanding the results of the ONTT.
OBJECTIVE: To determine whether the Optic Neuritis Treatment Trial (ONTT) results have altered the practice patterns of ophthalmologists and neurologists. DESIGN: Mail survey. PARTICIPANTS: A random sample of 987 ophthalmologists and 900 neurologists practicing in the United States were mailed a questionnaire that inquired into decision-making with regard to management of optic neuritis before and after the publication of the ONTT results. MAIN OUTCOME MEASURES: Responses received from 202 ophthalmologists and 244 neurologists, a response rate of 47%. RESULTS: Following the ONTT reports, nearly all ophthalmologists and neurologists have reduced their use of oral prednisone alone, substituting a regimen that includes intravenous methylprednisolone. A large proportion of practitioners in both specialties mistakenly believe that intravenous methylprednisolone treatment improves final visual outcome. Only 7% of neurologists and 36% of ophthalmologists (P = 0.0001) are adhering to the ONTT suggestion to use magnetic resonance imaging as a basis for initiating treatment. CONCLUSIONS: The ONTT has led to a dramatic reduction in the use of oral prednisone without a preceding course of intravenous methylprednisolone in the treatment of acute optic neuritis. Ophthalmologists and neurologists have changed some of their practices without fully understanding the results of the ONTT.
Authors: Stacy L Pineles; Grant T Liu; Amy T Waldman; Elizabeth Lazar; Mark J Kupersmith; Michael X Repka Journal: J Neuroophthalmol Date: 2016-06 Impact factor: 3.042