Significant Visual Field Defects Persist Despite Excellent Visual Acuity Following Optic Neuritis in...

Area of Science:

• Neuroscience
• Ophthalmology
• Immunology

Background:

• Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune disorder affecting the central nervous system.
• Optic neuritis (ON) is a common manifestation of MOGAD in adults, potentially causing severe visual acuity (VA) and visual field (VF) deficits.
• While VA typically improves with treatment, long-term VF outcomes in MOGAD-ON remain poorly understood.

Purpose of the Study:

• To analyze visual field (VF) deficits and recovery patterns in adult patients with MOGAD-associated optic neuritis (MOGAD-ON) following treatment.
• To compare the recovery of visual acuity (VA) versus visual fields (VFs) in MOGAD-ON patients.
• To identify factors influencing VF recovery and characterize persistent VF defects.

Main Methods:

• A multicenter, international, retrospective review of MOGAD-ON patients was conducted.
• Visual fields (VFs) were assessed at presentation and at least 3 months post-treatment, before relapse.
• VF severity was graded using mean deviation (MD) and specific deficit patterns were analyzed by a blinded neuro-ophthalmologist.

Main Results:

• Thirty-nine eyes from 28 MOGAD-ON patients were analyzed (mean age 39.68 years).
• The average mean deviation (MD) improved from -14.18 dB at presentation to -3.02 dB at follow-up.
• Despite VA recovery to 6/6, 46% of eyes had permanent VF deficits (MD < -2 dB) at follow-up, with 41% showing recognizable VF patterns.

Conclusions:

• Visual fields show poorer recovery compared to visual acuity in MOGAD-ON patients, with a significant proportion experiencing persistent deficits.
• Persistent VF deficits can occur even with good VA recovery, highlighting the importance of comprehensive visual assessment in MOGAD-ON.
• Altitudinal VF defects should not rule out MOGAD-ON, even in cases with prior optic neuropathy and disc edema.