Following optic neuritis, virtually all patients show some signs of optic nerve damage and most are symptomatic. Although visual acuity may return to normal, there is often still considerable abnormality in contrast sensitivity, color vision, perimetry and other measures. A treatment that would reduce the residual optic nerve damage produced by optic neuritis would be highly desirable. All previous studies on treatment of this condition have been inadequate. The current protocol was developed to determine whether treatment with corticosteroids (1) reduces residual visual dysfunction following optic neuritis or (2) speeds recovery of visual function. This study was also designed to compare oral prednisone therapy with high dose intravenous methylprednisolone. Based on a sample size estimate, 145 patients will be recruited for each of three treatment groups: placebo, oral prednisone, and intravenous methylprednisolone followed by oral prednisone. Outcome determinations will be made during the first month to assess the rate of improvement and at six months to assess the degree of residual visual dysfunction. Contrast sensitivity and perimetry will serve as the primary determinants of treatment effect. Visual acuity and color vision will also be assessed. The natural history of patients developing optic neuritis will be studied. Patients will be followed for five years to investigate the relationship between optic neuritis and multiple sclerosis. The study will also provide the opportunity to validate a computerized method of visual field analysis. This may have far reaching applications, well beyond optic neuritis, to glaucoma and other disorders of the visual field. This application proposes support for the Coordinating Center. Separate applications propose support for the Study Headquarters (Roy W. Beck, M.D., Principal Investigator) and for the Visual Field Center (John L. Keltner, M.D., Principal Investigator).
