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M.J. Kupersmith, H. Kaminski; Prospective Survey of NANOS and MGFA Members on Treatment of Ocular Myasthenia Gravis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5014.
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Purpose/objective: There is no consensus on treatment of ocular myasthenia gravis (OMG) to restore visual function or prevent or delay generalized disease. To determine how ophthalmologists or neurologists manage patients with OMG. Methods: Through the assistance of NANOS and the Myasthenia Gravis Foundation, we conducted a survey, via email, of ophthalmologists and neurologists members of both organizations. Members were asked whether they used corticosteroids to treat OMG, ptosis, diplopia, or ophthalmoparesis. The highest dose, duration of treatment, and highest maintenance dose were detailed. Results:Of the 121 MDs (65 neurologists, 56 ophthalmologists) who responded that they treat OMG from a possible 500, 89.2% of neurologists and 62.5% of ophthalmologists (p=.001) use steroids to treat OMG. Neurologists treat ptosis (49.2% vs. 33.9%, p=.1), ophthalmoparesis (89.2% vs. 57.1%, p=.01), and diplopia (86.2% vs. 62.5%, p=.003) more frequently than ophthalmologists. Of those who use steroids, neurologists (65.5%) and ophthalmologists (71.4%) have similar frequency of using more than 50 mg/day prednisone early in the course. However, ophthalmologists (60%) use maintenance doses < 10 mg/day more often than neurologists (39.7%). In contrast, neurologists (22.4%) use daily maintenance doses > 30 mg more often than ophthalmologists (8.6%). The duration of steroid use is similar for neurologist and ophthalmologists with 27.6% and 25.7% treating for < 1 year, with 24.1% and 37.1% treating for 1 to 3 years, and with 44.8% and 34.3% treating > 3 years. Conclusion: Even among experts in our survey and the literature controversy remains concerning steroid use, dose, and duration to treat OMG. Uncertainty remains due to the lack of prospective data, and our survey respondents considered it very important in 77.7% to determine whether steroids delay the onset of GMG, and it was considered very important in 88.4% to determine whether steroids reduce diplopia. We were surprised at the number of ophthalmologists who use corticosteroids for OMG although it was statistically less for neurologists. It is likely that the ophthalmologists in NANOS, all fellowship trained in Neuro–ophthalmology, are more comfortable with using systemic steroids, and contrasts with the experience of MJK over 23 years with New York metropolitan area ophthalmologists who demonstrate extreme reluctance to use prednisone in OMG.
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