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RCOphth Annual Congress 2026
18 - 21 May, 2026 | Manchester Central, Manchester
P238
Global Optic Neuritis Practice Patterns and Health System Resource Survey Explores Factors Impacting Outcomes
Poster Presenter
Authors
Cara Heppell, Manik Sharma, Anushka Irodi, K.D. Frick, Clare Fraser, Olufunmilola Ogun, Axel Petzold, Tasanee Braithwaite
Affiliations
Faculty of Life Science and Medicine, King's College London, London, UK, School of Clinical Medicine, University of Cambridge, UK, Johns Hopkins Carey Business School, USA, Sydney Eye Hospital, Australia, University of Ibadan, Nigeria, Institute of Neurology, University College London, London, UK; National Hospital for Neurology and Neurosurgery, London, UK; Moorfields Eye Hospital NHS Foundation Trust, London, UK,
Part of Topic
Neuro ophthalmology
Introduction
A recent systematic review (PROSPERO CRD420251160964)1 identifies few studies reporting on health systems and the resourcing and health economics of optic neuritis care internationally. This highlights potential for inequity in health and vision outcomes from optic neuritis.
Methods
We launched an online global optic neuritis clinical practice patterns and health system resourcing survey on 5/12/25 using Qualtrics. We used snowball sampling to invite senior and resident clinicians from eye emergency, inpatient, paediatric, neuro-ophthalmology and neurology settings. The study received ethics approval from King’s College London Ethics (LRS-24/25-51611).
Response rate and characteristics of health provider responders
557 providers responded, 309 of whom completed the majority of the survey.
Figure 1 | Global map illustrating distribution of survey responders who detailed their country name
Figure 2 | Providers responding to the survey.
Figure 3 | Setting survey responders worked in.
12 lower income (LIC) and lower middle incomecountries (LMIC), 15 upper middle incomecountries (UMIC), 30 high income countries (HIC).
84.1% worked in urban, 11.3% in mixed urban/rural, only 1.3% in rural settings.
The majority of responders see adult patients with ON (94.5%), while approximately half review children with ON (49.8%).
41.4% reviewed patients irrespective of their ability to pay and 47.2% responders work in settings that review a mixture of self-paying/insured and non-paying patients.
Access
Access to advice
Neuro-ophthalmology and neurology advice was available both during and outside working hours in 51.5% and 53.1% and only in working hours in 34.6% and 11.0%.
4.2% reported no specialist advice was available in the Eye Emergency setting.
Access to investigations
5.7% lack a visual field analyser, 3.1% OCT, 14.0% VEP, 4.2% urgent MRI, 5% LP, 23% anti-AQP4, 25.2% anti-MOG in their centre.
Health system funding models
Figure 4 | Health system funding models
Guidelines and perspectives on current practice
Appraisal of textbooks and journals in 57.9%, appraisal of medical literature in 56.6% and conferences in 55.3% most commonly informed providers current management in acute ON.
61.5% of providers report feeling very confident in managing ON and 30.9% reported feeling somewhat confident.
95.6% reported that they may admit patients with ON for inpatient management.
98.5% (265/269) providers reported offering high dose corticosteroids in the management of ON, where suspecting non-infectious and non-MS ON.
Figure 5 | Reasons cited for providers to opt for inpatient management of acute optic neuritis.
HIC, high income country; LIC, low income country; LMIC, lower middle income country; UMIC, upper middle incomecountryVisual outcomes in optic neuritis
70.4% reported most patients recover their pre-presentation VA but have an ongoing reduction in other aspects of their visual function 3 months following a single episode of potentially MS associated ON.
5.4% reported most do not recover pre-presentation VA and visual function.
60.2% reported that it was not very common for ON patients to lose driving level vision in the affected eye by 6 months after the acute episode.
20.5% reporting it was common and 4.7% very common.
Figure 6 | Reported contributing factors to incomplete recovery of vision function following an episode of optic neuritis.
HIC, high income country; LIC, low income country; LMIC, lower middle income country; UMIC, upper middle incomecountry.
Ongoing care and discharge following acute optic neuritis
10.4% (32/309) of providers discharge patients after a referral to neurology (to take over care) has been made, whilst 9.4% (29/309) discharge their patients once a referral to a dedicated neuro-ophthalmology service has been made.
The evidence base for acute optic neuritis
The most frequently cited limitation is that current guidelines are too heavily influenced by the Optic Neuritis Treatment Trial (ONTT) and does not apply to acute management of MOG- or AQP4- associated ON.
93.1% (243/261) of global providers state they would value access to a national or international consensus guideline to support standardisation in the management of ON.
87.7% would like to be involved in the development of future guidelines.
Conclusion
This study addresses unmet need for data insights into the role health systems and clinical practice variation play in outcomes from optic neuritis and will provide the first cost estimates for comparative health economic modelling.