Comparison of Early- and Late-Onset NMOSD-Related Optic Neuritis in Thai Patients: Clinical Characteristics and Long-Term Visual Outcomes

Abstract

Objective To compare demographic data, clinical and radiological characteristics, treatments, and long-term visual outcomes between patients with late-onset neuromyelitis optica spectrum disorder-related optic neuritis (LO-NMOSD-ON) (age at onset ≥ 50 years) and patients with early-onset neuromyelitis optica spectrum disorder-related optic neuritis (EO-NMOSD-ON) (age at onset < 50 years). Patients and Methods This retrospective study included 47 patients (69 eyes) who were diagnosed with neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) over a 12-year period. There were 14 patients (21 eyes) and 33 patients (48 eyes) in the LO-NMOSD-ON and EO-NMOSD-ON groups, respectively. Results LO-NMOSD-ON–affected eyes exhibited significantly worse median nadir visual acuity (VA) at optic neuritis (ON) onset, compared with EO-NMOSD-ON–affected eyes (2.7 logMAR (range 2.6–2.9 logMAR) vs 1.95 logMAR (range 0.4–2.9 logMAR); p = 0.03). Similarly, 100% of LO-NMOSD-ON–affected eyes demonstrated a nadir VA of worse than or equal to 1.0 logMAR, compared with 62.5% of EO-NMOSD-ON–affected eyes ( p = 0.03). LO-NMOSD-ON–affected eyes had a worse median final VA, compared with EO-NMOSD-ON–affected eyes (1.3 logMAR (range 0–2.9 logMAR) vs 0.3 logMAR (range 0–2.9 logMAR); adjusted p = 0.037). LO-NMOSD-ON–affected eyes more frequently exhibited a final VA of worse than or equal to 1.0 logMAR, compared with EO-NMOSD-ON–affected eyes (57.1% vs 27.0%; adjusted p = 0.039). A positive correlation was observed between age at ON onset of each eye and the final VA (logMAR) (Spearman r = 0.34, p = 0.0075). The remaining parameters did not significantly differ between the two groups. Conclusion Patients with LO-NMOSD-ON had significantly worse nadir VA at ON onset and significantly worse final VA, relative to patients with EO-NMOSD-ON. Age at ON onset of each eye was positively correlated with final VA (logMAR). Despite the difference in common age at onset, NMOSD-ON should be included in the differential diagnosis of late-onset acute to subacute optic neuropathy, along with ischemic optic neuropathy.

Relatively Early and Late-Onset Neuromyelitis Optica Spectrum Disorder in Central China: Clinical Characteristics and Prognostic Features

“…The latest EDSS score was 2.5 (1.1–4.9) in the REO-NMOSD group and 4.0 (3.0–6.9) in the RLO-NMOSD group after about 5 years of follow-up. Unlike the previous study ( 29 ), the severity of visual acuity showed no between-group differences no matter at onset or the nadir status. However, patients with RLO-NMOSD suffered from more serious sequelae than patients with REO-NMOSD.…”

Late-Onset Neuromyelitis Optica Spectrum Disorder Mimicking a Non-Arteritic Anterior Ischemic Optic Neuropathy–Case Report

“…However, it has been encountered among children and older adults as well. 6 Interestingly, in the majority of LO-NMOSD, the initial presentation is concomitant with findings of myelitis rather than ON. 14 Fundus examination in NMOSD is usually unremarkable.…”

“… 10 Furthermore, Papathanasiou et al 5 found that older age at the onset of NMOSD is a predictor of poor outcome, and patients with LO-NMOSD were expected to reach higher Expanded Disability Status Scale score during follow-up compared to those with early onset NMOSD (EO-NMOSD). Thongmee et al 6 indicated that patients with LO-NMOSD-ON had significantly worse nadir VA at ON onset as well as worse final VA compared to patients with EO-NMOSD-ON. There is no evidence that there is an arbitrary cut-off age at onset, rather clinical phenotypes and disability gradually change with time.…”

“…It is an exceedingly rare presentation associated with worse final visual outcome, greater susceptibility to disability, and higher mortality rate. 5 , 6 , 7 …”