OCT-Based Differentiation of First Acute Optic Neuritis
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND OBJECTIVES: Severe optic neuritis (ON) is a common clinical manifestation in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and neuromyelitis optica spectrum disorder (NMOSD). Given distinct prognoses and often the necessity of early plasma exchange in NMOSD, prompt differentiation is crucial. In this study, we investigated the utility of optical coherence tomography (OCT) in differentiating between first acute NMOSD-ON and MOGAD-associated optic neuritis (MOGAD-ON), as well as specific factors associated with disc edema. METHODS: In this retrospective multicenter study, 111 adult patients with MOGAD or aquaporin-4 antibody-positive NMOSD who experienced a first ON and underwent OCT within 2 weeks of symptom onset were included from 14 centers across 8 countries. Peripapillary retinal nerve fiber layer (pRNFL) thickness in µm was analyzed, including the average of both eyes in cases of bilateral manifestation. RESULTS: < 0.001). The pRNFL thickness cutoff of 117.5 µm provided 92.9% specificity and 71.1% sensitivity in distinguishing between MOGAD-ON and NMOSD-ON (area under the curve = 0.838). There was no association between pRNFL thickening and MOG-IgG titer (high vs low), body mass index, or the delay between ON onset and OCT. Simultaneous bilateral MOGAD-ON was associated with significantly more pronounced pRNFL thickening. DISCUSSION: Acute-stage OCT contributes to the rapid and accurate differentiation between MOGAD-ON and NMOSD-ON prior to antibody confirmation, which can be critical for timely therapeutic decisions.
Authors: Thivya Pakeerathan, James Davis, Amanda D. Henderson, Elias S. Sotirchos, Yana Said, Joachim Havla, Marius Ringelstein, Orhan Aktas, Margit Weise, Jonathan A. Gernert, Barbara Kornek, Gabriel Bsteh, Paulus S. Rommer, Nik Krajnc, Anne-Katrin Pröbstel, Athina Papadopoulou, Laila Kulsvehagen, Roxanne Pretzsch, Kean Schoenholzer, Tanyatuth Padungkiatsagul, Heather E. Moss, Sylvia E. Villarreal Navarro, Marina Herwerth, Madalina Graure, Veronika Kana, Hadas Stiebel-Kalish, Rita Zlatkin, Anthony C. Arnold, Laura Bonelli, Jan-Patrick Stellmann, Natacha Stolowy, Carolin Schwake, Christiane Schneider-Gold, Tania Kümpfel, Philipp Albrecht, Natthapon Rattanathamsakul, Sean J. Pittock, Eoin P. Flanagan, Sara Carta, Sara Mariotto, Ralf Gold, John J. Chen, Ilya Ayzenberg
Institutions: St. Josef-Hospital, Ruhr University Bochum, Johns Hopkins University, LMU Klinikum, Institut für Klinische Neuroimmunologie, Ludwig-Maximilians-Universität München, Heinrich Heine University Düsseldorf, Medical University of Vienna, University of Bonn, University of Basel, University Hospital Bonn, German Center for Neurodegenerative Diseases, University Hospital of Basel, Mahidol University, Ramathibodi Hospital, Stanford Medicine, Stanford University, University Hospital Zurich, Tel Aviv University, Rabin Medical Center, University of California, Los Angeles, Centre National de la Recherche Scientifique, Aix-Marseille Université, Centre de Résonance Magnétique Biologique et Médicale, Hôpital de la Timone, Kliniken Maria Hilf, Mayo Clinic, Siriraj Hospital, University of Verona
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,450
OpenAlex ID: W7118739766