Optic Neuritis - 3 years and no follow-up

  A male friend was diagnosed with optic neuritis 3+ years ago.  His eye sight returned to normal after 6-8 weeks -- no drugs were given.  To date, he has had no obvious symptoms of MS.  At the time, 2 neurologists told him there was no evidence of MS, to forget about it and get on with his life because even if it was MS, there was nothing they could do for him.  No MRI was done -- just a CAT scan to check for brain tumors and a clinical exam (no spinal tap, etc.).  He has had no follow-up since.
  Everything I have read of late supports an early diagnosis of MS because of the ABC drugs which have shown a decrease in exacerbations and have evidence of delaying onset.
  Is it too late to do a MRI and perfrom the other diagnostic tests available to attempt to determine his situation?  Would you agree with the opinion of having the earliest possible diagnosis, and if yes, is regular testing advised for someone who has had optic neuritis?  Would you suggest an appointment at the Mellen Center?
  Thank you.

Thank you for your question. Optic neuritis is a common symptom in MS, however the risk of progression to MS following an episode of unilateral optic neuritis is not 100%. In fact, it varies from 12 to 85% according to published studies. In a recent study of 457 patients with optic neuritis treated either with placebo, oral steroids, or IV steroids, the rate of progression to MS after 2 years ranged between 15 and 25%.
Two factors are important to refine the prognosis of optic neuritis:
1 - The presence of lesions on the MRI of the brain at the time of optic neuritis. If there is no lesion on the MRI at this time, the risk to develop MS is much lower. But I understand that your friend did not have an MRI initially.
2 - The recurrence of neurologic symptoms. If no other episode of neurologic symptoms occurs within 5 years following the first episode, then the risk of developing MS is also much lower. If your friend has been symptom-free for 3 years, this is reassuring.
You are right, it is now important to diagnose MS as soon as possible, in order to initiate a disease-modifying treatment if necessary. It is not too late to perform an MRI 3 years after an episode of optic neuritis, but the first step is to be examined by a neurologist. Making an appointment at the Mellen Center is a good idea. The phone number of the appointment desk at the Mellen Center is [phone].