Ocular manifestations of disease associated with the presence of antibodies to myelin oligodendrocyte glycoprotein
Abstract
Myelin oligodendrocyte glycoprotein antibody-positive disease (MOGAD) is a relatively new diagnostic entity that has emerged from the spectrum of neuromyelitis optica disorder (NMOSD), formerly also known as Devic's disease. This inflammatory autoimmune demyelinating disease affects the optic nerve, spinal cord and some other structures of the central nervous system.
One of the cardinal manifestations in adult patients is optic neuritis. In children, the disease manifests as acute demyelinating encephalomyelitis (ADEM).
The main diagnostic criteria are visible signs of CNS demyelination and detection of serum MOG-IgG antibodies. An attack of optic neuritis is accompanied by a severe visual deficit, which in most cases is at the level of counting fingers.
A relatively good adjustment of visual functions is typical. We can quantify the severity of the eye impairment using OCT (optical coherence tomography), where, despite the good adjustment of visual functions, we find a significant loss of nerve fibers.
Changes are seen in the optic nerve (pRNFL - peripapillary retinal nerve fiber layer) and macular area - ganglion cells (GCL - ganglion cell layer) and inner plexiform layer (IPL - inner plexiform layer). As a result of an attack of optic neuritis, there is a varying degree of impairment of visual functions and the optic nerve.
The severity of the disability is dependent on the timely initiation of therapy and the setting of chronic therapy to prevent further attacks of the disease. Interdisciplinary cooperation between a neurologist and an ophthalmologist is very important in the diagnosis of optic neuritis.