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Abstract Details

Isolated Optic Neuritis: Etiology, Characteristics, and Outcomes in a Large Single-center Cohort
Autoimmune Neurology
P9 - Poster Session 9 (8:00 AM-9:00 AM)
14-020
The association of ON with aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies has led to improved diagnosis and treatment. However, autoantibody-negative ON remains common.
To assess the demographic, clinical, and outcome data in patients with isolated optic neuritis (ON) across a large pediatric and adult cohort.
A retrospective chart review of University of Utah and Primary Children’s Hospital patients with diagnosis codes ICD-9 377.30 (optic neuritis unspecified), ICD9 377.39 (other optic neuritis), or ICD-10 H46 (optic neuritis) and at least 2 ophthalmologic evaluations between February 2011 and July 2023 was conducted. Only isolated ON without other brain or spinal demyelinating lesions were evaluated. 
Of 111 patients (19 children, 92 adults), 9/106 (8.5% with testing) were AQP4-IgG positive, and 35/96 (36.5% with testing) were MOG-IgG positive. Sixty-seven had other-ON of which 2 were ultimately diagnosed with recurrent isolated ON (RION), 2 with chronic relapsing inflammatory ON (CRION), 2 with multiple sclerosis, 1 with collapsing response-mediator protein-5-ON, and 1 with seronegative neuromyelitis optica spectrum disorder, during a median follow-up of 15 months. Five of them started long-term immunosuppressive therapy. No RION or CRION had preceding infections; they had the first recurrence of ON within 3 months. At presentation, AQP4-ON (75%) and MOG-ON (48.8%) had more severe vision loss (<20/200) compared to other-ON (23.6%) (P<0.01.) At the last follow-up, AQP4-ON (25%) had more severe visual (<20/200) acuity compared to MOG-ON (0%) and other-ON (1.4%) (P<0.01). Pediatric cases compared to adults frequently had bilateral ON (36.8% vs. 16.3%, P=0.04), preceding infection (47.4% vs. 20.7%, P=0.01), and disc edema (100% vs. 64%, P<0.01).  

Despite recent advances in testing availability for AQP4-IgG and MOG-IgG, over half of the patients with isolated ON remained negative for autoantibodies.  Recognizing the clinical features associated with isolated ON may help improve prognosis and treatment.

Authors/Disclosures
Yoji Hoshina, MD (University of Utah Health)
PRESENTER
Dr. Hoshina has nothing to disclose.
Meagan D. Seay, DO (UNIVERSITY OF UTAH MORAN EYE CENTER) Dr. Seay has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for various attorneys.
Ka-Ho Wong (U of U Neurology Clinic) The institution of Mr. Wong has received research support from The Sumaira Foundation .
Sravanthi Vegunta No disclosure on file
Melissa A. Wright, MD (University of Utah) Dr. Wright has nothing to disclose.
Tammy L. Smith, MD, PhD (Imaging and Neurosciences Center) The institution of Dr. Smith has received research support from Alexion/AstraZeneca. Dr. Smith has a non-compensated relationship as a participant with Euroimmun Academy, receiving travel support to attend, that is relevant to AAN interests or activities.
Stacey Clardy, MD, PhD, FAAN (University of Utah) Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca/Alexion. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from Sumaira Foundation for NMO. The institution of Dr. Clardy has received research support from NIH/NINDS. The institution of Dr. Clardy has received research support from SRNA. The institution of Dr. Clardy has received research support from Alexion/AstraZeneca. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel/Lodging/Honoraria with U of Iowa, Miami, Stanford, Barrow, Beaumont Health, CCF, Emory.