The neuroophthalmologist at Mayo Clinic discussed the current understanding of optic neuritis in neuromyelitis optica and the ways clinicians are working to improve recovery. [WATCH TIME: 4 minutes]
WATCH TIME: 4 minutes
"We’ve got some patients who come in with no light perception, we do everything we can with IV steroids, plasma exchange, etc., and they remain legally blind. It’s hard to predict who’s going to respond to treatment and who’s not."
Neuromyelitis optica (NMO) is an autoimmune demyelinating disease associated with recurrent episodes of optic neuritis and transverse myelitis, often resulting in permanent blindness and/or paralysis. The disease is caused by abnormal autoantibodies that bind to the aquaporin-4 protein, activating other parts of the immune system and causing inflammation and damage to cells. The FDA has approved 3 therapies—eculizumab (Soliris; Alexion), inebilizumab (Uplizna; Horizon), and satralizumab (Enspryng; Genentech)—which can reduce the risk of relapses in AQP4-positive NMO; however, there are no specific approved therapies for optic neuritis.
While most people regain close to normal vision within 6 months after an optic neuritis episode, there is a possibility it returns again. In these cases, individuals have an increased risk of developing multiple sclerosis (MS), NMO, or MOG antibody associated disorder. Optic neuritis can also recur in individuals without underlying conditions, and those people generally have a better long-term prognosis for their vision than patients with MS or NMO.
As part of neuromyelitis optica spectrum disorder (NMOSD) Awareness Month, NeurologyLive® sat down with John Chen, MD, PhD, a neuroophthalmologist at Mayo Clinic. Chen discussed the current understanding of optic neuritis in NMO, such as some of the complexities with treatment and predicting recovery. Additionally, he spoke on the unknown aspects of NMOSD, including the management and care for patients who are AQP4-seronegative.