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Updated: Jun 24, 2026

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
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Optical coherence tomography differs in neuromyelitis optica compared with multiple sclerosis.

R T Naismith1, N T Tutlam, J Xu

  • 1Department of Neurology, Washington University, Box 8111, 660 S. Euclid Ave., St. Louis, MO 63110, USA. naismithr@neuro.wustl.edu

Neurology
|March 25, 2009
PubMed
Summary

Neuromyelitis optica (NMO) causes greater axonal injury than multiple sclerosis (MS), indicated by thinner retinal nerve fiber layers after optic neuritis. Optical coherence tomography can help differentiate these conditions.

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Area of Science:

  • Neuroimmunology
  • Ophthalmology
  • Neurology

Background:

  • Neuromyelitis optica (NMO) and multiple sclerosis (MS) are inflammatory demyelinating diseases with distinct pathologies.
  • NMO involves destructive lesions and significant axonal injury, while MS disability results from demyelination and axonal damage.
  • Optical coherence tomography (OCT) measures retinal nerve fiber layer (RNFL) thickness as a biomarker for axonal injury.

Purpose of the Study:

  • To investigate if OCT can differentiate between NMO and MS based on axonal injury after optic neuritis (ON).
  • To compare RNFL thickness in NMO and MS patients with a history of ON.

Main Methods:

  • A cohort of 22 NMO/NMO spectrum disorder patients and 47 MS patients were analyzed.
  • OCT was used to measure RNFL thickness in eyes with a history of ON at least 6 months prior.
  • Linear mixed modeling controlled for visual acuity, contrast sensitivity, age, disease duration, and ON episodes.

Main Results:

  • NMO patients exhibited significantly thinner mean RNFL compared to MS patients (p=0.01 for visual acuity; p=0.02 for contrast sensitivity).
  • The superior and inferior quadrants of the RNFL were more severely affected in NMO.
  • These findings indicate greater axonal loss in NMO post-ON.

Conclusions:

  • Optic neuritis in NMO is associated with more severe axonal injury than in MS, evidenced by thinner RNFL.
  • OCT is a valuable tool for distinguishing NMO from MS and may serve as a surrogate marker for axonal damage in demyelinating optic neuropathies.