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Purpose: To study the clinical presentation, visual outcome, and predictors for both recurrence and poor visual recovery among optic neuritis (ON) patients in the Malaysian population.
Study design: Retrospective cohort study with longitudinal follow-up.
Methods: A total of 113 patients from the neuro-ophthalmology clinic fulfilling optic neuritis inclusion criteria within 4 weeks of onset were included. The study was conducted from May 2015 to June 2018. Demographic data, clinical findings, ophthalmological investigation, serological investigation, and imaging results were documented and tabulated. Patients were followed up to 1 year to assess the visual outcome and evidence of retinal nerve fibre layer (RNFL) thinning. Significant associative factors for recurrence and poor visual outcomes were identified using multivariate analysis.
Results: The age of the patients ranged from 13 to 71 years of age. The commonest age of presentation was 15–49 (67.3%) years of age. ON was predominant among Malays (65.5%), followed by Chinese (21.2%), and Indians (13.3%). The commonest form of ON was neuromyelitis optica spectrum disorder (NMOSD), which affected all ethnicities. Significant predictors for recurrence of ON were presentation within the 15–49 age group (p = 0.013) and presence of RNFL thinning following 1 year of treatment (p = 0.001). Indians had significantly lower odds of recurrence, 0.063 (p = 0.015). Significant variables associated with poor visual outcome > 6/18 were poor presenting vision > 6/18 (p < 0.001) and evidence of RNFL thinning following 1 year of treatment (p = 0.003). Females had better visual prognosis (p = 0.005) than males.
Conclusion: NMOSD was the commonest form of ON in our study population. The presenting age group of 15–49 along with the presence of RNFL thinning within 1 year of treatment were significantly associated with recurrence. Additionally, evidence of RNFL thinning and poor presenting vision > 6/18 were associated with a poor visual outcome. This group of patients will require regular monitoring and early access to treatment.