Retinal Nerve Fiber Layer May Be Better Preserved in MOG-IgG versus AQP4-IgG Optic Neuritis: A Cohort Study

Hadas Stiebel-Kalish, Itay Lotan, Judith Brody, Gabriel Chodick, Omer Bialer, Romain Marignier, Michael Bach, Mark Andrew Hellmann, Hadas Stiebel-Kalish, Itay Lotan, Judith Brody, Gabriel Chodick, Omer Bialer, Romain Marignier, Michael Bach, Mark Andrew Hellmann

Abstract

Background: Optic neuritis (ON) in patients with anti-myelin oligodendrocyte glycoprotein (MOG)-IgG antibodies has been associated with a better clinical outcome than anti-aquaporin 4 (AQP4)- IgG ON. Average retinal nerve fiber layer thickness (RNFL) correlates with visual outcome after ON.

Objectives: The aim of this study was to examine whether anti-MOG-IgG ON is associated with better average RNFL compared to anti-AQP4-IgG ON, and whether this corresponds with a better visual outcome.

Methods: A retrospective study was done in a consecutive cohort of patients following anti-AQP4-IgG and anti-MOG-IgG ON. A generalized estimating equation (GEE) models analysis was used to compare average RNFL outcomes in ON eyes of patients with MOG-IgG to AQP4-IgG-positive patients, after adjusting for the number of ON events. The final mean visual field defect and visual acuity were compared between ON eyes of MOG-IgG and AQP4-IgG-positive patients. A correlation between average RNFL and visual function was performed in all study eyes.

Results: Sixteen patients were analyzed; ten AQP4-IgG-positive and six MOG-IgG-positive. The six patients with MOG-IgG had ten ON events with disc edema, five of which were bilateral. In the AQP4-IgG-positive ON events, 1/10 patients had disc edema. Final average RNFL was significantly better in eyes following MOG-IgG-ON (75.33μm), compared to 63.63μm in AQP4-IgG-ON, after adjusting for the number of ON attacks (GEE, p = 0.023). Mean visual field defects were significantly smaller (GEE, p = 0.046) among MOG-IgG positive ON eyes compared to AQP-IgG positive ON eyes, but last visual acuity did not differ between the groups (GEE, p = 0.153). Among all eyes, average RNFL positively correlated with mean visual field defect (GEE, p = 0.00015) and negatively correlated with final visual acuity (GEE, p = 0.00005).

Conclusions: Following ON, RNFL is better preserved in eyes of patients with MOG-IgG antibodies compared to those with AQP4-IgG antibodies, correlating with better visual outcomes.

Conflict of interest statement

Dr. Marignier serves on the scientific advisory board for MedImmune and has received honoraria from Biogen Idec, MerckSerono, Novartis, and Sanofi-Genzyme. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. The distribution of average retinal…
Fig 1. The distribution of average retinal nerve fiber layer (RNFL) thickness (1a), final visual acuity (1b) and final mean visual field defect (1c) in ON affected eyes of 16 patients following 43 optic neuritis episodes.
1d: The distribution of average retinal nerve fiber layer (RNFL) thickness in eyes unaffected by ON. 1b: note inverted logMAR scale: better acuity at top. The bottom two points at 0.3 logMAR with the downward arrow represent two eyes that were effectively blind. Left boxplots: Eyes of AQP4 IgG-positive patients. Right boxplots: Eyes of MOG IgG-positive patients. VA = final visual acuity. VF = mean automated Humphrey visual field defect. Box plot details: thick horizontal bar: median. Box: interquartile range (25%–75%). Whiskers: range. Dots: outliers (data >1.5 times the interquartile range off the box). The “violin plots” in the background visualize a smoothened density estimate.

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