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Luv Patel, Lilangi S Ediriwickrema, Sachi Patel, Vivek Patel; Acute vision Loss Attributed to Optic Neuritis at a Level One Trauma Center and County Hospital. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5121.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the clinical profile of urgent vision loss due to optic neuritis at a level one trauma center and county hospital in downtown Los Angeles.
An IRB approved, retrospective chart review of 197 patients who received urgent ophthalmological consultation at the Los Angeles County Hospital, University of Southern California Medical Center was performed. 34 patients were identified based on the following targeted search terms: “optic neuritis,” “optic nerve enhancement” on neuroimaging, or constellation of “pain with extraocular movements” and signs of optic nerve disease including decreased color sensitivity and optical coherence tomography findings.
Of the 34 patients, 22 were female (64.7%). Twenty-five individuals were Hispanic (73.5%). Prior diagnoses included AIDS (n=1), cocaine use (n=1), diabetes (n=3), hypertension (n=3), anterior uveitis (n=1), and seizures (n=1). Nine of the patients presented with a known diagnosis, i.e. multiple sclerosis (n=3), neuromyelitis optica (n=1), meningioma (n=2), lymphoma (n=1), pituitary mass (n=1), and pseudomeningocele (n=1).While the predominant diagnosis was typical optic neuritis, MS, or NMO in 41.2%, other diagnoses included atypical optic neuritis, infectious, compressive, and infiltrative optic neuropathies, neuroretinitis, vasculitic infarct, vasculitic AION, and Vogt-Koyanagi-Harada syndrome.Of the 14 typical optic neuritis, MS, and NMO patients, two were diagnosed with NMO. Of the 12 remaining patients, the average age was 33 years; 75% were female, 58% presented with pain with extraocular movement, 33.3% had optic disc edema, and 100% had white matter disease, all of which were similar to that of the Optic Nerve Treatment Trial (ONTT) results. Follow-up ranged from one day to ten months, with 64.7% and 29.4% having a final visual acuity <20/40 or <20/200, respectively.
The clinical presentation of patients with optic neuritis can overlap with a host of other diagnoses. Sub-group analysis of predominately Hispanic and Black patients with demyelinating disease revealed similar characteristics to that of the ONTT but potentially suggest poorer visual outcomes than compared to Caucasians. The study is limited by short periods of patient follow-up due to recent diagnosis, suggesting the need for long-term studies regarding the visual outcomes and prognosis of optic neuritis in Hispanics and other minorities.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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