OCT retinal nerve fiber layer thickness differentiates acute optic neuritis from MOG antibody-associated disease and Multiple Sclerosis: RNFL thickening in acute optic neuritis from MOGAD vs MS
Issued Date
2022-02-01
Resource Type
ISSN
22110348
eISSN
22110356
Scopus ID
2-s2.0-85122673102
Pubmed ID
35038647
Journal Title
Multiple Sclerosis and Related Disorders
Volume
58
Rights Holder(s)
SCOPUS
Bibliographic Citation
Multiple Sclerosis and Related Disorders Vol.58 (2022)
Suggested Citation
Chen J.J. OCT retinal nerve fiber layer thickness differentiates acute optic neuritis from MOG antibody-associated disease and Multiple Sclerosis: RNFL thickening in acute optic neuritis from MOGAD vs MS. Multiple Sclerosis and Related Disorders Vol.58 (2022). doi:10.1016/j.msard.2022.103525 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86163
Title
OCT retinal nerve fiber layer thickness differentiates acute optic neuritis from MOG antibody-associated disease and Multiple Sclerosis: RNFL thickening in acute optic neuritis from MOGAD vs MS
Author(s)
Author's Affiliation
Hospital Universitario San Ignacio
University of California, Los Angeles
Mayo Clinic Scottsdale-Phoenix, Arizona
Charité – Universitätsmedizin Berlin
University of California, San Francisco
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Stanford University
Tel Aviv University
Mayo Clinic
Rutgers New Jersey Medical School
Mayo Clinic in Jacksonville, Florida
Johns Hopkins School of Medicine
Departments of Laboratory Medicine and Pathology
Departments of Neurology
Departments of Ophthalmology
University of California, Los Angeles
Mayo Clinic Scottsdale-Phoenix, Arizona
Charité – Universitätsmedizin Berlin
University of California, San Francisco
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Stanford University
Tel Aviv University
Mayo Clinic
Rutgers New Jersey Medical School
Mayo Clinic in Jacksonville, Florida
Johns Hopkins School of Medicine
Departments of Laboratory Medicine and Pathology
Departments of Neurology
Departments of Ophthalmology
Other Contributor(s)
Abstract
Background: Optic neuritis (ON) is the most common manifestation of myelin oligodendrocyte glycoprotein antibody associated disorder (MOGAD) and multiple sclerosis (MS). Acute ON in MOGAD is thought to be associated with more severe optic disk edema than in other demyelinating diseases, but this has not been quantitatively confirmed. The goal of this study was to determine whether optical coherence tomography (OCT) can distinguish acute ON in MOGAD from MS, and establish the sensitivity of OCT as a confirmatory biomarker of ON in these entities. Methods: This was a multicenter cross-sectional study of MOGAD and MS patients with peripapillary retinal nerve fiber layer (pRNFL) thickness measured with OCT within two weeks of acute ON symptom. Cirrus HD-OCT (Carl Zeiss Meditec, Inc. Dublin, CA, USA) was used to measure the pRNFL during acute ON. Eyes with prior ON or disk pallor were excluded. A receiver operating characteristic (ROC) curve analysis was performed to assess the ability of pRNFL thickness to distinguish MOGAD from MS. Results: Sixty-four MOGAD and 50 MS patients met study inclusion criteria. Median age was 46.5 years (interquartile range [IQR]: 34.3–57.0) for the MOGAD group and 30.4 years (IQR: 25.7–38.4) for the MS group (p<0.001). Thirty-nine (61%) of MOGAD patients were female compared to 42 (84%) for MS (p = 0.007). The median pRNFL thickness was 164 µm (IQR: 116–212) in 96 acute MOGAD ON eyes compared to 103 µm (IQR: 93–113) in 51 acute MS ON eyes (p<0.001). The ROC area under the curve for pRNFL thickness was 0.81 (95% confidence interval 0.74–0.88) to discriminate MOGAD from MS. The pRNFL cutoff that maximized Youden's index was 118 µm, which provided a sensitivity of 74% and specificity of 82% for MOGAD. Among 31 MOGAD and 48 MS eyes with an unaffected contralateral eye or a prior baseline, the symptomatic eye had a median estimated pRNFL thickening of 45 µm (IQR: 17–105) and 7.5 µm (IQR: 1–18), respectively (p<0.001). All MOGAD affected eyes had a ≥ 5 µm pRNFL thickening, whereas 26 (54%) MS affected eyes had a ≥ 5 µm thickening. Conclusion: OCT-derived pRNFL thickness in acute ON can help differentiate MOGAD from MS. This can aid with early diagnosis and guide disease-specific therapy in the acute setting before antibody testing returns, and help differentiate borderline cases. In addition, pRNFL thickening is a sensitive biomarker for confirming acute ON in MOGAD, which is clinically helpful and could be used for adjudication of attacks in future MOGAD clinical trials.