Structure-function Correlates in Myelin Oligodendrocyte Glycoprotein Antibody Disease Optic Neuritis
Ruby Ross1, Rachel Kenney1, Laura Balcer1, Steven Galetta1, Lauren Krupp1, Kimberly O'Neill1, Christina Marini1, Scott Grossman1
1NYU Grossman School of Medicine
Objective:

To characterize longitudinal focal optical coherence tomography (OCT) and visual function abnormalities in myelin oligodendrocyte glycoprotein (MOG) optic neuritis (ON).

Background:

MOG antibody disease is a demyelinating disorder that most commonly presents with optic neuritis (ON), and affects children more often than adults.

Design/Methods:

This is a retrospective case series of eight young patients with MOG-associated ON (MOG titer ≥1:100) who were referred for neuro-ophthalmic evaluation. Data for history, physical exam, and OCT obtained in the course of clinical evaluations were collected via medical record review. Stata statistical software was used to calculate Spearman correlations between visual function and OCT parameters.

Results:

Patients demonstrated acute peripapillary retinal nerve fiber layer (RNFL) thickening followed by steady RNFL thinning, with 9/16 and 11/16 eyes reaching significantly low RNFL thickness and papillomacular bundle (PMB) thickness, respectively (P<0.01). Concurrently, there was recovery of high-contrast visual acuity (HCVA) in all 5 affected eyes without recovery of contrast sensitivity (CS) in all but 1 of 11 affected eyes. There was no correlation between HCVA and OCT measures. By contrast, lower global RNFL thickness was associated with worse CS (rs=+0.36) and visual field depression (rs=+0.66). Lower PMB thickness was associated with worse CS, color vision by Ishihara plates, and visual field depression (rs=+0.42, +0.41, +0.38, respectively). Higher nasal/temporal ratio was associated with worse CS and less visual field depression (rs=-0.42, +0.48, respectively).

Conclusions:

MOG shows a pattern of prominent retinal atrophy, as demonstrated by global RNFL thinning, with remarkable preservation of HCVA but concurrent deficits in CS, color vision, and visual fields. These tests may be better clinical markers of vision changes secondary to MOG-ON. Of the OCT parameters measured, PMB thickness demonstrated the most consistent correlation between structural and functional measures. Thus, it may be a more sensitive marker of clinically significant retinal atrophy in MOG-ON than global RNFL thickness.

10.1212/WNL.0000000000204420