Public health implications of delayed diagnosis and treatment of optic neuritis in low-resource settings: a retrospective study of visual recovery outcomes.

Background: Optic neuritis (ON) is a common cause of visual loss in adults. It is commonly related to or occurs in the scenario of a demyelinating disease. Although treatment leads to visual recovery, diagnosis and treatment need to occur quickly, especially in lower-resource countries, where systems expect delays in care. Purpose: The goal of this study was to examine health-system delays in ON diagnosis and treatment and their effects on visual recovery. Methods: This retrospective review involved 100 cases of ON seen in a tertiary referral hospital from 2016 to 2023. Diagnosis was made of clinical features with confirmation by neuro-ophthalmological evaluation. MRI and visual evoked potentials (VEPs) were obtained if they were within reach. Visual recovery was defined as improvement of ≥3 Snellen lines at 3 months. Patients were given intravenous methylprednisolone (1 g/day for 3-5 days) and a tapered course of oral prednisolone. Delayed treatment was defined as the start of corticosteroids > 14 days after symptom onset, which was established for patients who did not start steroids on initial presentation. Logistic regression and ROC analysis were used to determine predictors of complete recovery. Results: 58% of patients experienced delayed treatment and had lower rates of complete visual recovery (31.0% vs. 66.7%, p < 0.01). Delayed treatment (OR 0.45; 95% CI 0.21-0.89) and baseline poor BCVA independently predicted poor visual recovery. Conclusion: In low-resource settings, the short-term visual outcomes of ON are worse with a delay in management. Prompt initiation of corticosteroids and improved referral pathways may aid in maximizing the recovery rate.