Elana Meer1, Kenneth S Shindler2, Yinxi Yu3, Brian L VanderBeek2,4,5. 1. University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania , USA. 2. Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania , USA. 3. Center for Preventative Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania , USA. 4. Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania , USA. 5. Department of Ophthalmology, Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine , Philadelphia , Pennsylvania , USA.
Abstract
Purpose: The Optic Neuritis Treatment Trial showed that an MRI of the brain is a powerful predictor of developing multiple sclerosis (MS). However, surveys of practitioners suggest that the recommended use of imaging is not consistently followed in practice. With this study, we aim to assess the rate at which newly diagnosed optic neuritis (ON) patients receive brain MRIs. Methods: This is a retrospective cohort study using administrative medical claims data from a large, national US insurer. All incident cases from 2000 to 2016 of ON in patients without MS were assessed. The primary outcome was a comparison of patterns of MRI scanning usage following diagnosis of ON. Secondary outcomes evaluated steroid treatment and progression to MS. Results: Of 2865 qualified ON patients, 1755 (61.3%) received a brain MRI. At 1 year follow-up, 629 (30.3%) patients had progressed to MS, a rate that increased slightly to 34.3% (366 patients) within a 3-year period of their initial ON diagnosis. A total of 520 (18.2%) patients received intravenous steroids, and 383 (13.4%) received oral steroids within 30 days of the ON diagnosis. Conclusion: Across the United States, a surprisingly low number of individuals obtain a brain MRI following onset of ON, suggesting that physicians may not be fully assessing the risk of MS.
Purpose: The Optic Neuritis Treatment Trial showed that an MRI of the brain is a powerful predictor of developing multiple sclerosis (MS). However, surveys of practitioners suggest that the recommended use of imaging is not consistently followed in practice. With this study, we aim to assess the rate at which newly diagnosed optic neuritis (ON) patients receive brain MRIs. Methods: This is a retrospective cohort study using administrative medical claims data from a large, national US insurer. All incident cases from 2000 to 2016 of ON in patients without MS were assessed. The primary outcome was a comparison of patterns of MRI scanning usage following diagnosis of ON. Secondary outcomes evaluated steroid treatment and progression to MS. Results: Of 2865 qualified ON patients, 1755 (61.3%) received a brain MRI. At 1 year follow-up, 629 (30.3%) patients had progressed to MS, a rate that increased slightly to 34.3% (366 patients) within a 3-year period of their initial ON diagnosis. A total of 520 (18.2%) patients received intravenous steroids, and 383 (13.4%) received oral steroids within 30 days of the ON diagnosis. Conclusion: Across the United States, a surprisingly low number of individuals obtain a brain MRI following onset of ON, suggesting that physicians may not be fully assessing the risk of MS.
Authors: Alan J Thompson; Brenda L Banwell; Frederik Barkhof; William M Carroll; Timothy Coetzee; Giancarlo Comi; Jorge Correale; Franz Fazekas; Massimo Filippi; Mark S Freedman; Kazuo Fujihara; Steven L Galetta; Hans Peter Hartung; Ludwig Kappos; Fred D Lublin; Ruth Ann Marrie; Aaron E Miller; David H Miller; Xavier Montalban; Ellen M Mowry; Per Soelberg Sorensen; Mar Tintoré; Anthony L Traboulsee; Maria Trojano; Bernard M J Uitdehaag; Sandra Vukusic; Emmanuelle Waubant; Brian G Weinshenker; Stephen C Reingold; Jeffrey A Cohen Journal: Lancet Neurol Date: 2017-12-21 Impact factor: 44.182
Authors: Sarah A Morrow; J Alexander Fraser; Chad Day; Denise Bowman; Heather Rosehart; Marcelo Kremenchutzky; Michael Nicolle Journal: JAMA Neurol Date: 2018-06-01 Impact factor: 18.302
Authors: Brian L Vanderbeek; David N Zacks; Nidhi Talwar; Bin Nan; David C Musch; Joshua D Stein Journal: Am J Ophthalmol Date: 2011-06-22 Impact factor: 5.258
Authors: Axel Petzold; Mike P Wattjes; Fiona Costello; Jose Flores-Rivera; Clare L Fraser; Kazuo Fujihara; Jacqueline Leavitt; Romain Marignier; Friedemann Paul; Sven Schippling; Christian Sindic; Pablo Villoslada; Brian Weinshenker; Gordon T Plant Journal: Nat Rev Neurol Date: 2014-07-08 Impact factor: 42.937
Authors: Lindsey B De Lott; Chun Chieh Lin; James F Burke; Beth Wallace; Daniel Saukkonen; Akbar K Waljee; Kevin A Kerber Journal: Ophthalmic Epidemiol Date: 2022-02-16