OCT-Based Differentiation of First Acute Optic Neuritis: An International Study of 111 Patients With NMOSD and MOGAD
Journal: Neurology Neuroimmunology & Neuroinflammation; January 7, 2026
Author(s): Thivya Pakeerathan , James Davis, Amanda D Henderson, Elias S Sotirchos, Yana Said, Joachim Havla, Marius Ringelstein, Orhan Aktas, Margit Weise, Jonathan A Gernert, Barbara Kornek, Gabriel Bsteh, Paulus S Rommer, Nik Krajnc, Anne-Katrin Pröbstel, Athina Papadopoulou, Laila Kulsvehagen, Roxanne Pretzsch, Kean Schoenholzer, Tanyatuth Padungkiatsagul, Heather E Moss, Sylvia E Villarreal Navarro, Marina Herwerth, Madalina Graure, Veronika Kana, Hadas Stiebel-Kalish, Rita Zlatkin, Anthony C Arnold, Laura Bonelli, Jan-Patrick Stellmann, Natacha Stolowy, Carolin Schwake, Christiane Schneider-Gold, Tania Kümpfel, Philipp Albrecht, Natthapon Rattanathamsakul, Sean J Pittock, Eoin P Flanagan, Sara Carta, Sara Mariotto, Ralf Gold, John J Chen, Ilya Ayzenberg
Could an eye test be used to distinguish between NMOSD and MOGAD in the first instance of optic nerve inflammation?
Inflammation of the optic nerve, known as optic neuritis, is a common first feature in MOGAD and NMOSD. In this study, researchers aimed to assess whether an eye test called optical coherence tomography (OCT) could help them distinguish between MOGAD and NMOSD at the first instance of optic neuritis.
The study included data from 111 adult patients — 83 with MOGAD and 28 with NMOSD positive for aquaporin4 (AQP4) antibodies, from 14 specialist centers across 8 countries. All patients had optic neuritis as their first sign of the condition and had undergone OCT within 2 weeks of experiencing symptoms of optic neuritis.The researchers focused on a specific factor, namely, the thickness of the retinal nerve fiber layer, which surrounds the optic nerve. This layer becomes thicker when the optic disc—the point where the optic nerve enters the eye—is swollen.
The retinal nerve fiber layer was considerably thicker than normal more often in MOGAD patients (73% cases) than in NMOSD patients (11%). If the fiber layer measured more than 117.5 mm in thickness, it strongly suggested MOGAD rather than NMOSD, but a measurement less than 117.5 mm did not mean that a MOGAD diagnosis could be ruled out.
Overall, the results indicated that quick OCT after optic neuritis first develops could give clues pointing towards MOGAD or NMOSD, but these findings must be assessed along with other clinical examinations, MRI results, and antibody tests.
Free Access: Free full text