Age-dependent favorable visual recovery despite significant retinal atrophy in pediatric MOGAD: how much retina do you really need to see well?

J Neuroinflammation. 2021 May 29;18(1):121. doi: 10.1186/s12974-021-02160-9.

Abstract

Background: To investigate age-related severity, patterns of retinal structural damage, and functional visual recovery in pediatric and adult cohorts of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) optic neuritis (ON).

Methods: All MOGAD patients from the 5 participating centers were included. Patients with initial manifestation <18 years were included in the pediatric (MOGADped) cohort and patients with ≥18 years in the adult (MOGADadult) cohort. For patients with MOGAD ON, examinations at least ≥6 months after ON onset were included in the analyses. Using spectral domain optical coherence tomography (SD-OCT), we acquired peripapillary retinal nerve fiber layer thickness (pRNFL) and volumes of combined ganglion cell and inner plexiform layer (GCIPL). High- and 2.5% low-contrast visual acuity (HCVA, LCVA) and visual-evoked potentials (VEP) were obtained.

Results: Twenty MOGADped (10.3±3.7 years, 30 MOGAD ON eyes) and 39 MOGADadult (34.9±11.6 years, 42 MOGAD ON eyes) patients were included. The average number of ON episodes per ON eye was similar in both groups (1.8±1.3 and 2.0±1.7). In both pediatric and adult MOGAD, ON led to pronounced neuroaxonal retinal atrophy (pRNFL: 63.1±18.7 and 64.3±22.9 μm; GCIPL: 0.42±0.09 and 0.44±0.13 mm3, respectively) and moderate delay of the VEP latencies (117.9±10.7 and 118.0±14.5 ms). In contrast, visual acuity was substantially better in children (HCVA: 51.4±9.3 vs. 35.0±20.6 raw letters, p=0.001; LCVA: 22.8±14.6 vs. 13.5±16.4, p=0.028). Complete visual recovery (HCVA-logMAR 0.0) occurred in 73.3% of MOGADped and 31% MOGADadults ON eyes, while 3.3% and 31% demonstrated moderate to severe (logMAR > 0.5) visual impairment. Independent of retinal atrophy, age at ON onset significantly correlated with visual outcome.

Conclusion: Pediatric MOGAD ON showed better visual recovery than adult MOGAD ON despite profound and almost identical neuroaxonal retinal atrophy. Age-related cortical neuroplasticity may account for the substantial discrepancy between structural changes and functional outcomes.

Keywords: MOGAD; Myelin oligodendrocyte glycoprotein IgG; Optic neuritis; Optical coherence tomography.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Atrophy / immunology
  • Autoimmune Diseases of the Nervous System* / classification
  • Autoimmune Diseases of the Nervous System* / complications
  • Autoimmune Diseases of the Nervous System* / diagnostic imaging
  • Child
  • Child, Preschool
  • Cohort Studies
  • Evoked Potentials, Visual
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myelin-Oligodendrocyte Glycoprotein / immunology
  • Optic Neuritis / complications
  • Optic Neuritis / immunology
  • Optic Neuritis / physiopathology*
  • Recovery of Function
  • Retina* / diagnostic imaging
  • Retina* / immunology
  • Retina* / physiopathology
  • Retinal Degeneration / immunology
  • Retinal Degeneration / physiopathology
  • Tomography, Optical Coherence
  • Vision Disorders / immunology
  • Vision Disorders / physiopathology*
  • Visual Acuity* / immunology

Substances

  • Myelin-Oligodendrocyte Glycoprotein