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Optic Neuritis In African-Americans

Arch Neurol Feb 1998;55:186-192
Paul H. Phillips, MD; Nancy J. Newman, MD; Michael J. Lynn, MS
PMID# 9482360
Abstract

Objective
To describe the clinical profile of DeMyelinating Optic Neuritis in African-Americans.

Methods
The medical records of all patients with a diagnosis of Optic Neuritis examined at the Neuro-Ophthalmology Unit at the Emory UnivEye Center (Emory) and at the Grady Memorial Hospital Eye Clinic (Grady), Atlanta, Ga, between 1989 and 1996 were retrospectively reviewed.

Patients
African-American and white patients, aged 15 through 55 years, with a single initial episode of acute Optic Neuritis of unknown or DeMyelinative origin were included in the study.

Study patients included 23 African-American patients and 56 white patients examined at Emory as well as 10 African-American patients examined at Grady.

Results
There were no significant differences among the African-American study patients, the white study patients, and patients from the Optic Neuritis Treatment Trial (ONTT) regarding sex (P=.36), age (P=.73).

Or the presence of disc Edema (P=.40), lesions found on Magnetic Resonance Imaging (P=.43), or Multiple Sclerosis (P=.54) at the onset of an initial episode of Optic Neuritis.

The Emory African-American patients presented with more frequent severe visual loss (13 [93%] of 14 patients with a Visual Acuity <20/200) compared with Emory white patients (12 [39%] of 31 patients; P=.002) and with ONTT patients (161 [36%] of 448 patients; P<.001).

At follow-up examination of at least 1 year, Emory African-American patients had worse vision (9 [39%] of 23 patients <20/40, and 4 [17%]of 23 patients <20/200) compared with Emory white patients (5 [8%] of 63 patients <20/40, P=.001; 3 [5%] of 63 patients <20/200, P=.08), and with ONTT patients (29 [7%] of 409 patients <20/40, P=.0001; 12 [3%] of 409 patients <20/200, P=.01).

Compared with ONTT patients, the Emory African-American patients combined with the Grady African American patients had more frequent severe visual loss (Visual Acuity <20/200) at presentation (18 [90%] of 20 patients vs 161 [36%] of 448 patients; P<.001) and at follow-up examination of at least 1 year (6 [18%] of 33 patients vs 12 [3%] of 409 patients; P=.002).

Seven (58%) of 12 African-American patients with Multiple Sclerosis had a "NeuroMyelitis Optica" presentation defined by the presence of Neurological deficits limited to the Optic Nerves and Spinal Cord.

Conclusions
The African-American study patients with a single episode of DeMyelinating Optic Neuritis had visual acuities more severely affected at onset and after 1 year of follow-up compared with the white study patients and with patients in the ONTT.

In the African-American patients, Multiple Sclerosis occurred most frequently in a "NeuroMyelitis Optica" form.



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