The ONTT (Optic Neuritis Treatment Trial) fundamentally changed the management of optic neuritis by demonstrating that:

• A IV methylprednisolone accelerated visual recovery but oral prednisolone alone increased the risk of recurrent optic neuritis compared to placebo ✓
• B IV methylprednisolone followed by oral prednisolone accelerated visual recovery and reduced the 2-year risk of developing multiple sclerosis
• C Oral prednisolone alone was superior to IV steroids for final visual outcome
• D Intravitreal steroids were equivalent to systemic therapy with fewer side effects

Explanation

The ONTT (Optic Neuritis Treatment Trial) demonstrated three key findings: (1) IV methylprednisolone (250 mg QID × 3 days) followed by oral prednisolone accelerated visual recovery but did not improve 6-month or 1-year final visual outcomes compared to placebo; (2) IV methylprednisolone reduced the 2-year risk of conversion to clinically definite MS (from 36% to 16%), though this benefit waned by 3 years; (3) crucially, oral prednisolone alone (1 mg/kg/day × 14 days) was associated with a statistically significantly higher rate of recurrent optic neuritis attacks compared to placebo, making oral prednisolone monotherapy CONTRAINDICATED in optic neuritis. This is one of the most clinically important and counterintuitive findings in neuro-ophthalmology.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.