This protocol covers first-line treatment for optic neuritis. The central aim is recovery of vision, and the regimen is structured around achieving that goal as effectively as possible.
First-line management is built around intravenous corticosteroid therapy, followed by an oral steroid course. A key point: oral corticosteroids in conventional doses alone are contraindicated as the primary treatment. The complete regimen — including agent selection, sequencing, and the transition criteria — is available in the full protocol.
Recovery of vision is the primary endpoint.
Target: visual acuity 20/40 or better by 6 monthsDOI: 10.4103/0301-4738.77020
The patients were randomized into 3 different treatment groups: oral placebo for 14 days; intravenous methylprednisolone (250 mg, 6 hourly) for 3 days, followed by oral prednisolone (1 mg\kg\d) for 11 days and a 3-day tapering of prednisolone thereafter; oral prednisolone (1 mg\kg\d) for 14 days, followed by a 3-day tapering.
At our center, we routinely use 200 mg intravenous dexamethasone for 3 days, followed by oral prednisolone.
Treatment with oral prednisolone in conventional doses alone, is contraindicated.
More than 90% of the patients recover a visual acuity of 20/40 or better by 6 months, as seen in the ONTT.
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