High resolution retinal scanning reveals regional structural differences between MS and NMOSD optic neuritis regardless of antibody status

Background There is a need for biomarkers that can classify optic neuritis (ON) attacks as belonging to either neuromyelitis optica spectrum disorder with optic neuritis (NMOSD-ON) or relapsing remitting multiple sclerosis with optic neuritis (MS-ON). This study uses spectral domain optical coherence tomography (SD-OCT) data to perform a preliminary contrast between NMOSD-ON and MS-ON by analyzing peripapillary retinal nerve fiber layer and intra-macular layer patterns of injury. Methods In this cross-sectional study, we used SD-OCT to obtain peripapillary retinal nerve fiber layer and intra-macular layer data for 26 NMOSD-ON, 25 MS-ON, and 26 healthy control (HC) age-matched eyes. Additionally, sub-comparisons compared 11 NMOSD-ON eyes that were seronegative for IgG antibodies against aquaporin 4 (NMOSD-ON (−)) and 16 NMOSD-ON eyes that were seropositive (NMOSD-ON (+)) to age-matched MS-ON eyes. Layer thicknesses were assessed using an automated algorithm and were then statistically compared using generalized estimating equations to account for inter-eye correlations. Results Selective thinning was found in the pRNFL, mRNFL, and GCL in NMOSD-ON compared to MS-ON. Thinning in the pRNFL nasal sector was found to persist in both NMOSD-ON (−) (P = 0.017) and NMOSD-ON (+) (P = 0.021) compared to MS-ON. Thinning in the mRNFL temporal sector was found to persist in NMOSD-ON (+) compared to MS-ON. Diffuse thinning was found in the pRNFL, mRNFL, GCL and IPL in NMOSD-ON compared to HC, and while diffuse thinning was also found in the GCL and IPL in MS-ON compared to HC, selective thinning was found in the pRNFL and mRNFL. Conclusion The nasal region of the pRNFL may be capable of distinguishing between NMOSD-ON and MS-ON regardless of antibody status. Additionally, NMOSD-ON may cause more profound nasal axonal and inferior arcuate neuronal degeneration compared to MS-ON.