The ONTT (Optic Neuritis Treatment Trial) provided which specific management guideline that changed clinical practice for optic neuritis?
- A IV methylprednisolone 1 g/day for 3 days accelerates visual recovery but oral steroids alone increase the relapse rate ✓
- B Oral prednisolone 1 mg/kg/day accelerates visual recovery and reduces long-term MS risk
- C Subcutaneous interferon beta-1a reduces conversion to MS when started immediately after optic neuritis
- D No treatment yields equivalent long-term visual outcomes to IV methylprednisolone
Correct answer: A. IV methylprednisolone 1 g/day for 3 days accelerates visual recovery but oral steroids alone increase the relapse rate
Explanation
The ONTT demonstrated that IV methylprednisolone (1 g/day × 3 days followed by oral taper) accelerated visual recovery compared to placebo or oral prednisone alone, but that all groups reached similar visual acuity at 1 year. Critically, oral prednisone alone (1 mg/kg/day) was associated with an increased rate of new episodes of optic neuritis and is therefore contraindicated as a standalone treatment. IV steroids did transiently reduce the risk of MS conversion over 2 years, but this effect was not sustained beyond 3 years.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.