Myelin Oligodendrocyte Glycoprotein-Related Optic Neuritis and Chiasmitis Mimicking Nonarteritic Anterior Ischemic Optic Neuropathy

Handzic, Armin; Brossard-Barbosa, Natalie; Margolin, Edward

doi:10.1097/wno.0000000000001962

Cited by 3 publications

(3 citation statements)

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“…NA-AION and optic neuritis are the most common acute optic neuropathies in adults and the most common causes of unilateral OD edema [111]; most importantly, they may have an overlapping clinical profile that can sometimes make clinical differentiation a challenge [114,116,117]. However, younger age, female sex, better initial acuity, hyperemic OD edema, central scotoma, pain with eye movement, no FAG feature of OD ischemia, early recovery of VA and good response to treatment with intravenous steroids with an overall better long-term prognosis generally propend for the diagnosis of optic neuritis; whereas advanced age, male sex, poor initial acuity, altitudinal VF defect, segmental OD edema, absence of pain, presence of FAG signs of OD and/or peripapillary choroid ischemia, less favorable long-term prognosis with less improvement in VA, worse response to steroids and the presence of systemic hypertension or diabetes suggest the diagnosis of NA-AION [114,116] (Tables 1 and 2).…”

Section: Differential Diagnosis (Dd) In the Acute Na-aion Stagementioning

confidence: 99%

“…Rizzo & Lessell reported that, amongst their NA-AION patients, 8% complained of pain 26% had a central scotoma, whereas 10% of the optic neuritis patients had an altitudinal VF defect [116]. Patients with MOG-associated optic neuritis have a typical OD swelling with hemorrhages upon onset but, differently from NA-AION patients, they show a rapid recovery of visual function in the majority of cases, with a good final prognosis [116,117]; c. Diabetic papillopathy: the currently accepted criteria for the diagnosis of this clinical entity include: the presence of diabetes type 1 or 2; unilateral or bilateral OD edema, frequently hyperemic and with marked dilatation of the OD surface microvasculature; the absence of OD dysfunction, except for a minor RAPD; minimal VF defects with no altitudinal pattern; and lack of evidence of ocular inflammation or elevated intracranial pressure [15,118]. A crowded OD in the fellow eye is frequently present [15].…”

Section: Differential Diagnosis (Dd) In the Acute Na-aion Stagementioning

confidence: 99%

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Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

Salvetat,

Pellegrini,

Spadea

et al. 2023

Vision

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Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.

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Section: Differential Diagnosis (Dd) In the Acute Na-aion Stagementioning

confidence: 99%

Section: Differential Diagnosis (Dd) In the Acute Na-aion Stagementioning

confidence: 99%

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

Salvetat,

Pellegrini,

Spadea

et al. 2023

Vision

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“…However, myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD), a demyelinating disease that is distinct from MS, is associated with optic neuritis that has optic disc edema in 80% of cases. 2 Therefore, in older adults, acute vision loss with optic disc edema from MOGAD-ON may pose a diagnostic challenge with NAION, 3 - 5 which is the most common cause of acute optic neuropathy in this age group. 6 In addition, MOG-IgG alone is not diagnostic of MOGAD if the titer is low or not known, and supporting clinical or imaging features will be required.…”

Section: Introductionmentioning

confidence: 99%

Acute Optic Neuropathy in Older Adults

Tisavipat,

Stiebel-Kalish,

Palevski

et al. 2024

Neurol Neuroimmunol Neuroinflamm

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Background and Objectives Myelin oligodendrocyte glycoprotein antibody-associated disease optic neuritis (MOGAD-ON) and nonarteritic anterior ischemic optic neuropathy (NAION) can cause acute optic neuropathy in older adults but have different managements. We aimed to determine differentiating factors between MOGAD-ON and NAION and the frequency of serum MOG-IgG false positivity among patients with NAION. Methods In this international, multicenter, case-control study at tertiary neuro-ophthalmology centers, patients with MOGAD presenting with unilateral optic neuritis as their first attack at age 45 years or older and age-matched and sex-matched patients with NAION were included. Comorbidities, clinical presentations, acute optic disc findings, optical coherence tomography (OCT) findings, and outcomes were compared between MOGAD-ON and NAION. Multivariate analysis was performed to find statistically significant predictors of MOGAD-ON. A separate review of consecutive NAION patients seen at Mayo Clinic, Rochester, from 2018 to 2022, was conducted to estimate the frequency of false-positive MOG-IgG in this population. Results Sixty-four patients with unilateral MOGAD-ON were compared with 64 patients with NAION. Among patients with MOGAD-ON, the median age at onset was 56 (interquartile range [IQR] 50–61) years, 70% were female, and 78% were White. Multivariate analysis showed that eye pain was strongly associated with MOGAD-ON (OR 32.905; 95% CI 2.299–473.181), while crowded optic disc (OR 0.033; 95% CI 0.002–0.492) and altitudinal visual field defect (OR 0.028; 95% CI 0.002–0.521) were strongly associated with NAION. On OCT, peripapillary retinal nerve fiber layer (pRNFL) thickness in unilateral MOGAD-ON was lower than in NAION (median 114 vs 201 μm, p < 0.001; median pRNFL thickening 25 vs 102 μm, p < 0.001). MOGAD-ON had more severe vision loss at nadir (median logMAR 1.0 vs 0.3, p < 0.001), but better recovery (median logMAR 0.1 vs 0.3, p = 0.002). In the cohort of consecutive NAION patients, 66/212 (31%) patients with NAION were tested for MOG-IgG and 8% (95% CI 1%–14%) of those had false-positive serum MOG-IgG at low titers. Discussion Acute unilateral optic neuropathy with optic disc edema in older adults can be caused by either MOGAD-ON or NAION. Detailed history, the degree of pRNFL swelling on OCT, and visual outcomes can help differentiate the entities and prevent indiscriminate serum MOG-IgG testing in all patients with acute optic neuropathy.

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Applying the 2022 optic neuritis criteria to noninflammatory optic neuropathies with optic nerve T2-hyperintensity: an observational study

Labella Álvarez,

Biousse,

Mosleh

et al. 2024

J Neurol

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Myelin Oligodendrocyte Glycoprotein-Related Optic Neuritis and Chiasmitis Mimicking Nonarteritic Anterior Ischemic Optic Neuropathy

Cited by 3 publications

References 5 publications

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview

Acute Optic Neuropathy in Older Adults

Applying the 2022 optic neuritis criteria to noninflammatory optic neuropathies with optic nerve T2-hyperintensity: an observational study

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