Current landscape of pediatric optic neuritis management in India: A clinical practice survey

Purpose: To understand the practice patterns in the management of pediatric optic neuritis in India and detect the gaps in evaluation and management. Methods: An online survey-based study questionnaire was shared among ophthalmologists in the last quarter of 2024. The questionnaire included questions pertaining to the clinical experience, evaluation, and management of optic neuritis in children. Results: Seventy ophthalmologists across India participated in the survey. Of these, 45% had a formal neuro-ophthalmology training and 42% had more than 5 years of experience in managing pediatric optic neuritis. Most respondents managed under less than five cases every month. Participants with under 5 years’ clinical experience reported higher rates of myelin oligodendrocyte glycoprotein-associated disease and post-infectious ON followed by neuromyelitis optica spectrum disorder, multiple sclerosis, and chronic relapsing inflammatory optic neuritis. Visual fields (50%) and optical coherence tomography (45%) were frequently requested ocular investigations. Magnetic resonance imaging brain and spine with contrast and fat-suppressed sequence was recommended by 23% of respondents, serological workup in 91%, and cerebrospinal fluid analysis in 17%. For treatment, intravenous methylprednisolone (IVMP) was used by 94% for 3 days (45%) or 5 days (53%). 34% ophthalmologists advised IVMP dosing at 30 mg/kg. In recurrent cases, those with less than 5 years’ experience more often repeated neuroimaging ( P = 0.050) and initiated IVMP irrespective of vision ( P = 0.046). Conclusions: This survey highlights the variability in diagnostic testing and management practices of pediatric optic neuritis among ophthalmologists in India underscoring the need for developing, guiding, and following standardized practice guidelines.