The ONTT (Optic Neuritis Treatment Trial) demonstrated which key finding regarding long-term visual outcomes and MS risk?

• A IV methylprednisolone significantly improved 10-year visual acuity compared to oral prednisone or placebo
• B Oral prednisone was superior to IV treatment in preventing long-term MS development
• C No treatment was superior; all three arms had equivalent visual acuity at 15 years and equivalent MS conversion rates
• D IV methylprednisolone sped visual recovery at 3 months but did not improve 15-year visual outcomes; oral prednisone alone increased MS risk and recurrence ✓

Explanation

The ONTT showed that IV methylprednisolone (1 g/day for 3 days followed by oral taper) accelerated visual recovery at 3 months but did not improve long-term (15-year) visual acuity compared to placebo. Crucially, oral prednisone alone (1 mg/kg/day) significantly increased the rate of optic neuritis recurrence and was not recommended. The MRI at presentation was the strongest predictor of MS development (lesion burden). IV steroids reduced short-term MS risk in high-MRI-lesion patients, but this effect was not sustained beyond 2 years.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.