St. Thomas Hospital
Medical Eye Unit

Author Of 1 Presentation

Epidemiology Poster Presentation

P0499 - The epidemiology of optic neuritis in the United Kingdom and implications for consensus diagnostic criteria for multiple sclerosis. (ID 409)

Speakers
Presentation Number
P0499
Presentation Topic
Epidemiology

Abstract

Background

The epidemiology of optic neuritis (ON) has been studied less carefully than the epidemiology of multiple sclerosis (MS). The association of ON with many other diseases poses one of several challenges for inclusion of ON in consensus diagnostic criteria for MS.

Objectives

To investigate current trends in ON incidence, prevalence and associations with systemic and neurological diseases in the United Kingdom (UK).

Methods

We used The Health Improvement Network (THIN), a nationally representative primary care records database to conduct a retrospective cross-sectional and population cohort study (1997-2018), and matched case-control and cohort study (1995-2020) (matched 4:1 on age, sex, region and Townsend Deprivation Index[TDI]).

Results

We included 11,086,469 patients with 75 million patient-years of follow-up. Amongst 2,895 incident cases with ON, 69.5%(n=2011) were female (mean age at diagnosis 41.6 (sd15.6)), 92.5% (n=1,227/1,326) were white and 24.9% were in TDI quintile 1 (no deprivation). The annual point prevalence (per 100,000 people) steadily increased from 69.3 (95%CI 57.2-81.3) in 1997 to 114.8 (95%CI 111.0-118.6) in 2018. The annual incidence rate was stable over 22 years, at 3.7 (95% CI 3.6-3.9) per 100,000 person-years. Highest risk of incident ON was associated with female sex, obesity, reproductive age, mixed or South Asian ethnicity, smoking, and Scottish residence; compared to children ≤10 years at cohort entry, adjusted incident rate ratio was >6-fold higher in women aged 21-40 years (p<0.001). In multivariable logistic regression, ON cases had significantly higher odds of prior diagnosis of MS (17.3%, OR 98.2, 95%CI 65.4-147.5), syphilis (0.2%, OR 5.8, 95%CI 1.4-23.7), mycoplasma (0.2%, OR3.90,1.09-13.93), vasculitis(0.5%, OR3.70,1.68-8.15), sarcoidosis(0.5%, OR2.50,1.21-5.18), Epstein Barr virus(3.8% OR2.29,1.80-2.92), Crohn’s disease(0.7%, OR1.97,1.13-3.43), and psoriasis(4.3%, OR1.28,1.03-1.58). ON patients had significantly higher hazard of incident MS(adjusted HR285.0,167.9-483.8), Behçet’s disease(HR17.4,1.6-195.5), sarcoidosis(HR14.8,4.9-45.1), vasculitis(HR4.9,1.8-13.1), Sjögren’s syndrome(HR3.5,1.4-8.8), and herpetic infection (HR1.7,1.2-2.3).

Conclusions

This large, population-representative study reveals stable incidence of ON in the UK over a 22-year period, and provides evidence-based guidance for investigation of MS and non-MS ON. Careful exclusion of non-MS ON patients, a sizable proportion, will be relevant for future revision of consensus MS diagnostic criteria, to minimize misdiagnosis.

Collapse