![]() 3 Severe vision loss to worse than 20/200 is common in children with optic neuritis (90 to 95 percent), in contrast to adults in the optic neuritis treatment trial, of whom 64 percent had visual acuities better than 20/200. Pain or pain with eye movement isn’t a consistent feature of pediatric optic neuritis therefore the absence of pain doesn’t rule out optic neuritis. A meta-analysis of isolated pediatric optic neuritis studies found that 72 percent of children under the age of 10 presented with bilateral involvement, while in children older than 10 years, 70 percent presented with unilateral optic neuritis. Bilateral involvement is more common in children than in adults, and often a child will present to the emergency room only if bilateral simultaneous disease occurs, or after the second eye becomes involved. Children with optic neuritis may go without detection of the disease until one eye is incidentally covered or closed for some reason, leading the child to complain that he can’t see and prompting a visit to the ophthalmologist or the emergency room. As a result, determining exactly when vision loss occurred may not be feasible. ![]() Obtaining a clear history of the illness can be difficult, if not impossible, in children. Patients in the pediatric age range may present with different clinical characteristics than those found in adults. With pain on eye movement, often in the presence of a relative afferent pupillary defect unless the disease is bilateral and symmetric. Fundus photographs of a patient with optic neuritis in the right eye demonstrating optic nerve edema. Optic neuritis is commonly defined as the clinical presentation of decreased vision, impaired color vision or visual field defectsįigure 1. In this article, we’ll cover the various aspects of optic neuritis in pediatric patients that the ophthalmologist needs to know. Differences in presentation and underlying causes of optic neuritis in children are important to understand in order to avoid misdiagnosis and to guide neuroimaging and laboratory testing. Though this disease is more common in adults, the pediatric ophthalmologist should also be aware of it, as well as its evaluation and treatment, because associations between optic neuritis and other neuro-inflammatory syndromes may affect final visual and systemic outcomes. Prospective treatment trials are needed to determine the best course of treatment, and until then, treatment plans must be individualized to the clinical manifestations and severity of disease.Īcute disseminating encephalomyelitis (ADEM) Aquaporin-4 (AQP4) Multiple sclerosis Myelin oligodendrocyte glycoprotein (MOG) Neuromyelitis optica spectrum disorder (NMOSD) Optic neuritis.O ptic neuritis is defined as an inflammatory disease of the optic nerve. There is now sufficient evidence to separate MOGAD from other inflammatory central nervous system demyelinating disorders, which will allow focused research on understanding the pathophysiology of the disease. Based on contemporary studies, it has become increasingly evident that MOGAD is distinct from multiple sclerosis and aquaporin-4-positive neuromyelitis optica spectrum disorder with different clinical features and treatment outcomes. ![]() The recent development of a reproducible, live cell-based assay for MOG-IgG, has improved our ability to identify and study this disease. In this review, we summarize the current knowledge of the clinical characteristics, neuroimaging, treatments, and outcomes of MOGAD, with a focus on optic neuritis. ![]() Antibodies against myelin oligodendrocyte glycoprotein (MOG) are associated with a unique acquired central nervous system demyelinating disease-termed MOG-IgG-associated disorder (MOGAD)-which has a variety of clinical manifestations, including optic neuritis, transverse myelitis, acute disseminating encephalomyelitis, and brainstem encephalitis. ![]()
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