Epidemiologic and Clinical Characteristics of Optic Neuritis in Japan

Abstract

Purpose: To elucidate the clinical and epidemiologic characteristics of optic neuritis in Japan. Design: Multicenter cross-sectional, observational cohort study. Participants: A total of 531 cases of unilateral or bilateral noninfectious optic neuritis identified in 33 institutions nationwide in Japan. Methods: Serum samples from patients with optic neuritis were tested for antieaquaporin-4 antibodies (AQP4-Abs) and antiemyelin oligodendrocyte glycoprotein antibodies (MOG-Abs) using a cell-based assay and were correlated with the clinical findings. Main Outcome Measures: Antibody positivity, clinical and radiologic characteristics, and visual outcome. Results: Among 531 cases of optic neuritis, 12% were AQP4-Ab positive, 10% were MOG-Ab positive, 77% were negative for both antibodies (double-negative), and 1 case was positive for both antibodies. Pretreatment visual acuity (VA) worsened to more than a median 1.0 logarithm of the minimum angle of resolution (logMAR) in all groups. After steroid pulse therapy (combined with plasmapheresis in 32% of patients in AQP4-Abepositive group), median VA improved to 0.4 logMAR in the AQP4-Abepositive group, 0 logMAR in the MOG-Abepositive group, and 0.1 logMAR in the double-negative group. The AQP4-Abepositive group showed a high proportion of females, exhibited diverse visual field abnormalities, and demonstrated concurrent spinal cord lesions on magnetic resonance imaging (MRI) in 22% of the patients. In the MOG-Abepositive group, although posttreatment visual outcome was good, the rates of optic disc swelling and pain with eye movement were significantly higher than those in the AQP4-Abepositive and double-negative groups. However, most cases showed isolated optic neuritis lesions on MRI. In the double-negative group, 4% of the patients had multiple sclerosis. Multivariate logistic regression analysis of all participants identified age and presence of antibodies (MOG-Ab and AQP4-Ab) as significant factors affecting visual outcome. Conclusions: The present large-scale cohort study revealed the clinicoepidemiologic features of noninfectious optic neuritis in Japan. Antieaquaporin-4 antibodyepositive optic neuritis has poor visual outcome. In contrast, MOG-Ab positive cases manifested severe clinical findings of optic neuritis before treatment, but few showed concurrent lesions in sites other than the optic nerve and generally showed good treatment response with favorable visual outcome. These findings indicate that autoantibody measurement is useful for prompt diagnosis and proper management of optic neuritis that tends to become refractory.

<p>Etiologies of Acute Optic Neuritis in Thailand: An Observational Study of 171 Patients</p>

“…The etiologies were generally similar to those observed in other Asian countries. [23][24][25][26][27] The results were also comparable to those reported in Chiangmai, which lies in northern Thailand. 28 A slight difference is that the number of MS cases was relatively higher in Chiangmai Province.…”

AQP4-IgG and MOG-IgG Related Optic Neuritis—Prevalence, Optical Coherence Tomography Findings, and Visual Outcomes: A Systematic Review and Meta-Analysis

“…Notably, cohorts from China comprised the vast majority of the Asian cohorts in our study. However, relatively high seroprevalence of AQP4-IgG and/or MOG-IgG in ON has been reported in several studies (that did not however fully fulfill our inclusion criteria) from Japan, Thailand, Malaysia, and additional Chinese centers ( 74 , 77 , 86 – 89 ). Importantly, while population-based studies support the notion that Eastern Asian populations have a higher prevalence of NMOSD compared to Caucasian populations, MOG-IgG-associated disease does not appear to exhibit a significant racial preponderance based on data from existing hospital-based studies ( 90 ).…”

Rapid Administration of High-Dose Intravenous Methylprednisolone Improves Visual Outcomes After Optic Neuritis in Patients With AQP4-IgG-Positive NMOSD

“…However, as patients with AQP4-ON are recommended to receive IVMP pulse therapy as soon as possible after clinical onset, clinicians are often required to proceed with IVMP pulse therapy administration before obtaining the results of serological tests for serum AQP4-IgG positivity. Although the majority of patients with AQP4-ON are female, the proportions of female patients in AQP4-ON cohorts of previous studies involving different ethnicities varied to some extent between 80 and 95% (53)(54)(55). Thus, regardless of the sex of patients with ON, clinicians may consider administering IVMP pulse therapy before confirming the positivity of serum AQP4-IgG once the rare differential diagnosis of infectious ON has been ruled out or considered unlikely.…”