Plasma exchange helps enhance vision in patients with acute optic neuritis

Plasma exchange (PLEX) appears to improve visual outcomes in acute optic neuritis (ON), reveals a study. Vision loss severity, older age, prior ON in the affected eye, and delay to PLEX tend to contribute to less visual recovery.

The investigators performed literature searches with no date restrictions and limited to studies published in English in January 2025 using the PubMed database. They identified 207 citations, of which 39 were reviewed in full text. Of these, 12 articles met the eligibility criteria and were assigned a level of evidence rating by the panel methodologist.

Two studies were rated level II, and 10 studies level III. The two level II studies reported improvements in visual outcomes following treatment with PLEX for acute ON compared with a comparative or historical cohort of patients who received corticosteroids alone. The 10 studies either had no comparative arm (n=9) or lacked specific visual acuity outcomes (n=1) and were thus rated level III.

Ten studies included patients with neuromyelitis optic spectrum disorder ON, and all of them achieved some degree of visual recovery after PLEX. In other studies that included other ON causes, most noted improvements in vision after PLEX in those with multiple sclerosis, myelin oligodendrocyte glycoprotein antibody-associated disease ON, or both, but outcomes for treatment of idiopathic ON were mixed.

Furthermore, the following factors correlated with worse visual outcomes: severe vision loss at the time of PLEX, older age, history of prior ON in the affected eye, and delay in PLEX. Major complications rarely occurred and primarily included issues related to central line placement.

“Future randomized clinical trials will be required to confirm level I evidence for the efficacy of PLEX treatment in ON and to help determine the optimal timing for treatment and which patients would be most likely to benefit,” the investigators said.