Clinical characteristics and prognosis of optic neuritis in Taiwan - a hospital-based cohort study

Chao-Wen Lin; Wei-Tse Chen; Yen-Heng Lin; Kuang Hung; Ta-Ching Chen

doi:10.1016/j.msard.2023.104739

Clinical characteristics and prognosis of optic neuritis in Taiwan - a hospital-based cohort study

Mult Scler Relat Disord. 2023 Jul:75:104739. doi: 10.1016/j.msard.2023.104739. Epub 2023 Apr 29.

Authors

Chao-Wen Lin¹, Wei-Tse Chen², Yen-Heng Lin³, Kuang Hung³, Ta-Ching Chen⁴

Affiliations

¹ Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, Taiwan.
² Department of Medical Education, National Taiwan University Hospital, Taiwan.
³ Department of Medical Imaging, National Taiwan University Hospital, Taiwan.
⁴ Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, Taiwan; Center of Frontier Medicine, National Taiwan University Hospital, Taiwan. Electronic address: tachingchen1@ntu.edu.tw.

PMID: 37148579
DOI: 10.1016/j.msard.2023.104739

Abstract

Background: Optic neuritis (ON) is an inflammatory disease of optic nerve. The distinct etiologies of ON significantly influence its clinical manifestation, neuroimaging findings, and visual outcomes. However, the clinical characteristics might be influenced by the racial differences. The purpose of this study is to investigate the clinical characteristics of various types of ON at a Taiwanese tertiary center.

Methods: This cohort study analyzed 163 patients who received treatment and continued following-up for ON between 2015 and 2022. We selected patients who had been tested for anti-aquaporin-4 antibody (AQP4-Ab) and anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab). The participants were classified into four groups on the basis of their etiologies, specifically (1) multiple sclerosis (MS)-related, (2) AQP4-Ab-positive, (3) MOG-Ab-positive, or (4) idiopathic ON. The researchers recorded the patients' clinical characteristics, treatment course, magnetic resonance imaging and optical coherence tomography (OCT) findings, and visual outcomes.

Results: MOG-Ab-positive group had higher percentages of disk swelling and pain with eye movement. Long optic nerve and perineural enhancement are the hallmarks of MOG-Ab-related ON. The ON relapse rate was higher in AQP4-Ab-positive group. Although members of AQP4-Ab-positive group received immediate steroid pulse therapy, these patients experienced the worst visual outcomes. Moreover, a thinner retinal nerve fiber layer (RNFL) was noted in AQP4-Ab-positive group. MS group had a higher incidence of extra-optic nerve lesions. Multivariate regression identified pretreatment visual acuity and RNFL thickness as the important factors affecting visual outcomes.

Conclusions: This cohort study identified the clinical features of different types of ON. Patients with AQP4-Ab-positive ON had poorer visual outcomes, which may be attributed to multiple relapses and profound nerve damage, as revealed by OCT findings. Patients with MOG-Ab-positive ON displayed long optic nerve enhancement but had more favorable prognoses. Thus, antibody-based classification facilitates treatment and prognosis in ON.

Keywords: Aquaporin-4; MRI; Multiple sclerosis; Myelin oligodendrocyte glycoprotein; Optic neuritis; Optical coherence tomography.

MeSH terms

Aquaporin 4
Autoantibodies*
Cohort Studies
Humans
Myelin-Oligodendrocyte Glycoprotein
Optic Neuritis* / diagnostic imaging
Optic Neuritis* / drug therapy
Optic Neuritis* / epidemiology
Prognosis
Taiwan / epidemiology

Substances

Autoantibodies
Aquaporin 4
Myelin-Oligodendrocyte Glycoprotein