Should Aquaporin-4 Antibody Test Be Performed in all Patients With Isolated Optic Neuritis? : Journal of Neuro-Ophthalmology

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Should Aquaporin-4 Antibody Test Be Performed in all Patients With Isolated Optic Neuritis?

Siantar, Rosalynn G. MBBS, MMed, FRCOphth, FAMS; Ibrahim, Farah N.I. MBBS, MMed; Htoon, Hla M. BDS, PhD; Tow, Sharon L.C. MBBS, FRCS(Ed), FAMS; Goh, Kong Yong MBBS, MMed, FRCS(Ed), FRCOphth, FAMS; Loo, Jing Liang MBBS, MMed, FRCS(Ed), FAMS; Lim, Su Ann MBBS, MMed, FRCS(Ed); Milea, Dan MD, PhD; Tien, Melissa C.H. MBBS, MMed, FAMS; Chen, Zhiyong MBBS, MRCP, MMed; Yeo, Tianrong MBBS, MRCP, MMed, FAMS, MCI; Chai, Josiah Y.H. MBBS, MRCP, FRCP, FAMS; Singhal, Shweta MBBS, MMed, FRCOphth, FAMS, PhD; Chin, Chee Fang MBChB, MMed, MRCS(Ed), FRCS(Ed), FAMS; Tan, Kevin BMedSci, BMBS, MRCP, FAMS, MS-HPEd

Editor(s): Fraser, Clare MD; Mollan, Susan MD

Author Information

National Healthcare Group Eye Institute (RGS, SAL, MT, CFC), Tan Tock Seng Hospital, Singapore; Department of Neuro-Ophthalmology (FI, ST, JLL, DM, SS), Singapore National Eye Centre, Singapore; Data Science Unit (HMH), Singapore Eye Research Institute, Singapore; Mount Elizabeth Novena Hospital (KYG), Singapore; Department of Neurology (ZC, TY, JC, KT), National Neuroscience Institute, Singapore; and Duke-NUS Medical School (KT), Singapore

Address correspondence to Shweta Singhal, MBBS, MMed, FRCOphth, FAMS, PhD, Department of Neuro-Ophthalmology, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751; E-mail: [email protected]

K. Tan has received travel grants and compensation from Novartis, Merck, Sanofi, Eisai, and Viela Bio for consulting services. The remaining authors report no conflicts of interest.

R.G. Siantar and F. Ibrahim contributed equally as first authors of the manuscript.

C.F. Chin and K. Tan contributed equally as senior authors of manuscript.

Journal of Neuro-Ophthalmology 42(4):p 454-461, December 2022. | DOI: 10.1097/WNO.0000000000001573

Abstract

Background: 

Optic neuritis (ON) may be the initial manifestation of neuromyelitis optica spectrum disorder (NMOSD). Aquaporin-4 antibody (AQP4 Ab) is used to diagnose NMOSD. This has implications on prognosis and is important for optimal management. We aim to evaluate if clinical features can distinguish AQP4 Ab seropositive and seronegative ON patients.

Methods: 

We reviewed patients with first episode of isolated ON from Tan Tock Seng Hospital and Singapore National Eye Centre who tested for AQP4 Ab from 2008 to 2017. Demographic and clinical data were compared between seropositive and seronegative patients.

Results: 

Among 106 patients (120 eyes) with first episode of isolated ON, 23 (26 eyes; 22%) were AQP4 Ab positive and 83 (94 eyes; 78%) were AQP4 Ab negative. At presentation, AQP4 Ab positive patients had older mean onset age (47.9 ± 13.6 vs 36.8 ± 12.6 years, P < 0.001), worse nadir VA (OR 1.714; 95% CI, 1.36 to 2.16; P < 0.001), less optic disc swelling (OR 5.04; 95% CI, 1.682 to 15.073; p = 0.004), and higher proportions of concomitant anti-Ro antibody (17% vs 4%, p = 0.038) and anti-La antibody (17% vs 1%, p = 0.008). More AQP4 Ab positive patients received steroid-sparing immunosuppressants (74% vs 19%, p < 0.001) and plasma exchange (13% vs 0%, p = 0.009). AQP4 Ab positive patients had worse mean logMAR VA (visual acuity) at 12 months (0.70 ± 0.3 vs 0.29 ± 0.5, p = 0.051) and 36 months (0.37±0.4 vs 0.14 ± 0.2, p = 0.048) follow-up.

Conclusion: 

Other than older onset age and retrobulbar optic neuritis, clinical features are non-discriminatory for NMOSD. We propose a low threshold for AQP4 Ab serology testing in inflammatory ON patients, particularly in high NMOSD prevalence populations, to minimize diagnostic and treatment delays.

Copyright © 2022 by North American Neuro-Ophthalmology Society

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