Traditionally , treatment of optic neuritis that improve final visual acuity is not proven.
Optic neuritis treatment trials (ONTT) have reported that systemic corticosteroid did not improve final visual acuity. As a result, ophthalmologists should explain hazards and benefits of systemic corticosteroid, and the decision is up to the patients.
I think that this situation is kind of awkward because the patients don’t have any idea about the treatment of optic neuritis and doctors may seem to be incompetent.
During my short term training in Kinki University, Japan, the professor Nakao has recommended systemic corticosteroid to the patients.
That’s because the possibility of neuromyelitis optica (NMO).
The patients of NMO should be treated using systemic corticosteroid as soon as possible. If the patients do not respond, plasma exchange should be considered.