Patients With Double-Antibody Seronegative NMOSD Experience Severe Retina Damage After Optic Neuritis

In a cross-sectional study, researchers found that severe retinal damage occurs following optic neuritis (ON), with most of the damage occurring during the first ON episode. Researchers also found that neurodegeneration occurred independent of an ON attack.

For their study, researchers included cross-sectional data of 25 people (48 eyes) with neuromyelitis optica spectrum disorders (DN-NMOSD) with and without a history of ON. For comparison purposes, data was also included from 25 people with aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (AQP4-NMOSD, 46 eyes) and from 25 healthy controls (HCs, 49 eyes). All groups were matched for age and sex. The groups included in the study were from the collaborative retrospective study of retinal optical coherence tomography (OCT) in neuromyelitis optica (CROCTINO), a collaborative multicenter study.

To determine retinal damage, all patients underwent OCT with central postprocessing, local neurologic examination, and antibody testing. The researchers quantified retinal neurodegeneration as “peripapillary retinal nerve fiber layer thickness (pRNFL) and combined ganglion cell and inner plexiform layer thickness (GCIPL).”

The results indicated that patients with DN-NMOSD eyes after ON had thinner pRNFL (p < 0.001) and GCIPL (p = 0.023) compared with the eyes of HCs.

“Even after only one ON episode, DN-NMOSD eyes already had considerable neuroaxonal loss compared with HCs,” the authors wrote.

In patients with DN-NMOSD eyes without a history of ON, pRNFL and GCIPL were reduced compared with eyes of HCs. Researchers found no differences in pRNFL and GCIPL between the DN-NMOSD group and the AQP4-NMOSD group.

This study had limitations. For example, the authors noted that the lack of imaging of the retina and optic nerve during the acute attack limited their understanding of acute ON-related damage patterns in patients with DN-NMOSD.

“DN-NMOSD is characterized by severe retinal neurodegeneration after ON and attack-independent retinal damage. Most of the damage occurs during the first ON episode,”the authors concluded. “This highlights the need for diagnostic imaging markers for DN-NMOSD to facilitate an earlier diagnosis as well as for effective attack treatments.”

Reference
Oertel FC, Zimmermann HG, Motamedi S, et al. Retinal changes in double-antibody seronegative neuromyelitis optica spectrum disorders. Neurol Neuroimmunol Neuroinflamm. 2024;11(5):e200273. doi:10.1212/NXI.0000000000200273