title: Optic neuritis in an ethnically diverse population: higher risk of atypical cases in patients of African or African-Caribbean heritage.
abstract: OBJECTIVE
  To investigate the presence of an ethnicity bias within patients presenting with optic neuritis in London.
  
  
  METHODS
  Observational cross-sectional study.
  
  
  METHODS
  The ethnicity profile of all patients attending a neuro-ophthalmology clinic in central London with acute optic neuritis over a 16month period (n=86) was studied. A comparison was made with the ethnicity profile of the population of London as well as patients with Multiple Sclerosis-associated optic neuritis (n=41), Neuromyelitis Optica spectrum disorder-associated optic neuritis (n=27) and patients with an atypical corticosteroid-dependent optic neuropathy (21).
  
  
  RESULTS
  The ethnicity profile of the patient cohort presenting to our clinic with acute optic neuritis over a 16 month period closely matched the ethnicity profile of London (P=0.08). Within this cohort, patients of African or African-Caribbean heritage were found to be more likely to manifest either a pattern or aetiology of optic neuritis requiring immunosuppressive treatment in comparison with patients of a white Caucasian background (relative risk 3.47; 95% CI=1.092 to 11.007). There was a disproportionately high representation of patients from an African or African-Caribbean background within the Neuromyelitis Optica spectrum-related optic neuritis diagnostic group (P<0.00).
  
  
  CONCLUSIONS
  Patients with acute isolated optic neuritis from African or African Caribbean backgrounds are over 3 times more likely than patients of white Caucasian backgrounds to have an 'atypical' pattern of optic neuritis where corticosteroid therapy may be required. Our results suggest that a patient's ethnic background is an important factor to be taken into consideration when deciding on the diagnosis and management of acute isolated optic neuritis.
authors.affiliation: The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. m.storoni@doctors.net.uk
authors.forename: Mithu
authors.initials: M
authors.lastname: Storoni
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Pittock
authors.forename: Brian G
authors.initials: BG
authors.lastname: Weinshenker
authors.forename: Gordon T
authors.initials: GT
authors.lastname: Plant
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D044383:Black People; D017691:Caribbean Region / Q000208:ethnology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000208:ethnology*; D009902:Optic Neuritis / Q000188:drug therapy / Q000208:ethnology*; D012307:Risk Factors; D044465:White People
chemical_list: D000305:Adrenal Cortex Hormones