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To assess the risk of developing multiple sclerosis (MS) after optic neuritis and the factors predictive of high and low risk.Subjects in the Optic Neuritis Treatment Trial, who were enrolled between July 1, 1988, and June 30, 1991, were followed up prospectively for 15 years, with the final examination in 2006.Neurologic and ophthalmologic examinations at 13 clinical sites.Three hundred eighty-nine subjects with acute optic neuritis.Development of MS and neurologic disability assessment.The cumulative probability of developing MS by 15 years after onset of optic neuritis was 50% (95% confidence interval, 44%-56%) and strongly related to presence of lesions on a baseline non-contrast-enhanced magnetic resonance imaging (MRI) of the brain. Twenty-five percent of patients with no lesions on baseline brain MRI developed MS during follow-up compared with 72% of patients with 1 or more lesions. After 10 years, the risk of developing MS was very low for patients without baseline lesions but remained substantial for those with lesions. Among patients without lesions on MRI, baseline factors associated with a substantially lower risk for MS included male sex, optic disc swelling, and certain atypical features of optic neuritis.The presence of brain MRI abnormalities at the time of an optic neuritis attack is a strong predictor of the 15-year risk of MS. In the absence of MRI-detected lesions, male sex, optic disc swelling, and atypical clinical features of optic neuritis are associated with a low likelihood of developing MS. This natural history information is important when considering prophylactic treatment for MS at the time of a first acute onset of optic neuritis.

Tobacco-alcohol amblyopia or toxic-nutritional optic neuropathy is a condition characterised by papillomacular bundle damage, central or caecocentral scotoma, and reduction of colour vision in a patient who abuses tobacco and alcohol.1,2 There is consensus that nutritional deficiency has an important role as well.3,4 The appearance of the optic nerve is usually normal, but peripapillary dilated vessels and haemorrhages have been described.5,6 Testing with static perimetry often reveals central scotomas. Although this syndrome has been classified as optic neuropathy, the primary lesion has not actually been localised to the optic nerve and may possibly originate in the retina, chiasm, or even the optic tracts. We report two cases of tobacco-alcohol amblyopia and their electrophysiological findings after testing with multifocal electroretinography (MERG). ### Case 1 A 47 year old woman presented with gradual decrease in vision over 4 months. Her medical history showed that she has been in excellent health. She smoked one pack of cigarettes per week and had two to three beers daily. She denied any use of any medications in the past few months. She and her husband have been …

Aim: To determine the anatomical site and extent of electrophysiological dysfunction in patients with ethambutol associated visual loss. Methods: A comparative case series. Four patients with ethambutol associated visual loss underwent multifocal electroretinography (mERG). Two patients had advanced visual loss while two had early signs of toxicity. The N1-P1, N1, P1 amplitudes, N1, and P1 latencies were compared to 10 age and sex matched controls. Results: mERG abnormalities were detected in the ethambutol treated patients. The N1 amplitude was significantly lower in the ethambutol treated patients than in the control group. Conclusion: Ethambutol is possibly toxic to the retina, and not only the optic nerve. The multifocal ERG may be of value to diagnose and monitor patients taking ethambutol.

Background/aim: Fractionated stereotactic radiotherapy (FSRT) is a new treatment for brain tumours that are close to critical structures, such as the visual apparatus. This study aims to assess the visual outcomes for patients with parasellar meningioma following FSRT. Methods: A retrospective, non-comparative case series of 13 patients with parasellar meningiomas who were treated in one institution with FSRT between January 1995 and January 2001. Results: 13 patients (26 eyes) were followed for a mean of 2 years. Visual acuity improved in four eyes (12.5%), remained stable in 18 eyes (75%), and worsened in three eyes (12.5%). Visual field improved in 15 eyes (57%), remained stable in six eyes (23%), and worsened in four eyes (15%). No adverse visual outcome occurred as a result of radiation. Conclusion: These preliminary findings suggest that FSRT is a safe and effective treatment for parasellar meningiomas.

We measured contrast sensitivity by means of Arden grating plates in 41 eyes with acute optic neuritis and in 51 eyes with resolved optic neuritis. The scores were abnormal in 93% of eyes in the acute phase and 78% in the resolved phase irrespective of visual acuity. Even when acuity improved to 6/7.5 or better with resolution of the neuritis, 67% of eyes still showed abnormal contrast sensitivity. Since Snellen acuity represents just one point at the high spatial frequency end of the contrast sensitivity function, a patient in whom acuity improves to 6/6 with resolution of optic neuritis may still have difficulty seeing objects of lower relative contrast or at lower spatial frequencies.

A 75-year-old healthy woman developed uveitis and chorioretinal infiltrates OD compatible with reticulum cell sarcoma. She was admitted to hospital 18 months later with somnolence and confusion. Examination revealed diffuse white matter hypodensity on computed tomography and a persistent cerebrospinal fluid pleocytosis. At necropsy reticulum cell sarcoma was found in the right globe and Aspergillus fumigatus was present in almost every other organ, including the brain.