Neuro-ophthalmologist, Peter O’Donnell Jr. Brain Institute, UT Southwestern Medical Center

Melanie Truong-Le, DO, OD

“I see a lot of burden on our patients because of this condition and I also see the hope that we have in terms of understanding this process so much more now than we used to. Overall, if we can find a way in which we can diagnose [NMOSD] early and start the treatment early, I think the overcoming factor will be improved for the patient.”

For patients with neuromyelitis optica spectrum disorder (NMOSD), early diagnosis and treatment is crucial, according to Melanie Truong-Le, DO, OD, neuro-ophthalmologist, UT Southwestern Medical Center. Although, to receive treatment, which is often infusion based, patients need to be in a large medical center, making access difficult in addition to high associated costs. Truong-Le spoke with 

 on the need to improve patient outcomes and further reduce uncertainty and the burden of associated health conditions such as anxiety and depression. 

Also discussed was the state of the pipeline, with Truong-Le commenting on her interest in evidence-based research on when to interrupt or discontinue therapy, as well as the state of care. She further stressed the need to work on getting the treatments that they require early on in order to “tailor their treatment” when optic neuritis is associated with the diagnosis. 

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The neuro-ophthalmologist at UT Southwestern further discussed the high cost of treatment for patients with neuromyelitis optica spectrum disorder and the need to improve access to care.  

Addressing the Current State of Care, Pipeline in NMOSD: Melanie Truong-Le, DO, OD

“Previously, we used ELISA [enzyme-linked immunosorbent assay] or the fluorescence sorting method to detect the antibodies, and we found that the sensitivity and specificity was not as high. So, with the use of cell-based assays, our detection rate for these antibodies is just so much more sensitive and specific, and that has helped us to diagnose, fully, these patients with more confidence. With that confidence, I think we are able to manage and treat them much more appropriately.”

Melanie Truong-Le, DO, OD, neuro-ophthalmologist, Peter O’Donnell Jr. Brain Institute, UT Southwestern Medical Center, sat down with 

 to discuss the clinical application of new technology for neuromyelitis optica spectrum disorder (NMOSD), as it relates to the treatment of optic neuritis. Truong-Le offered a unique perspective as a neuro-ophthalmologist, commenting on the use of optical coherence tomography (OCT), a noninvasive imaging technique using light rays to look at nerve fiber layer.

According to Truong-Le the pattern of thinning in the ganglion cell layer is different in NMOSD and multiple sclerosis, which is key for diagnosis. Further discussed were technological advances associated with aquaporin-4 antibody detection, as well as with the myelin oligodendrocyte glycoprotein antibody detection. Experts have veered away from the enzyme-linked immunosorbent assay (ELISA) and the fluorescence sorting method to identify these antibodies, Truong-Le said, in favor of cell-based assays to provide for more confident diagnoses. 

The neuro-ophthalmologist at UT Southwestern Medical Center discussed optical coherence tomography and antibody detection technology used to diagnose optic neuritis associated with NMOSD.  

Optic Neuritis and NMOSD Diagnosis: Melanie Truong-Le, DO, OD

“It's so important to recognize the condition really early on. Very much like in neurology and stroke, we find that time is brain, and time is vision, as well. So, if we were able to see these patients early on, identify them, and treat them, the outcome is so much better.”

Within the field of neuromyelitis optica spectrum disorder (NMOSD) care, discoveries over the last few years have assisted in the ability to recognize and diagnose the condition earlier on, improving patient outcomes. Despite previous beliefs that NMOSD was part of the multiple sclerosis (MS) disease spectrum, it is now understood that it is related to the aquaporin-4 (AQP4) antibody, and according to Melanie Truong-Le, DO, OD, neuro-ophthalmologist, Peter O’Donnell Jr. Brain Institute, UT Southwestern Medical Center, identification of AQP4 has helped to “drive care” within neuro-ophthalmology specifically. 

, Truong-Le further delved into a discussion of differentiating divisions of optic neuritis, as typical optical neuritis is related to MS, and atypical optical neuritis is often found with NMOSD. With these variations, providers also see a different pattern of enhancement and different effects and involvement with the optic nerve, with providers now relying on images to inform diagnosis. The relation of the myelin oligodendrocyte glycoprotein antibody to optic neuritis, the pathogenicity of which is not yet fully understood, is another area that has assisted in acute diagnosis, Truong-Le said. 

Discussing NMOSD’s relation to AQP4 and pattern enhancement on MRIs, the neuro-ophthalmologist at UT Southwestern Medical Center further commented on the importance of early diagnosis.  

Melanie Truong-Le, DO, OD

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Addressing the Current State of Care, Pipeline in NMOSD: Melanie Truong-Le, DO, OD

Optic Neuritis and NMOSD Diagnosis: Melanie Truong-Le, DO, OD

Recent Advancements in NMOSD Clinical Care: Melanie Truong-Le, DO, OD

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