To determine the fundoscopic findings in acute optic neuritis (ON) from myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and their association with visual outcomes

ON is the most common presentation of MOGAD and is often associated with optic disc edema (ODE) and occasionally other retinal findings, but their frequency and clinical implications have not been systematically explored.

A retrospective chart review of patients evaluated at Mayo Clinic between 1/1/00-2/28/24 and fulfilling the 2023 international MOGAD criteria was performed. Patients with fundoscopic examination within 2 weeks of the first ON attack and follow-up ≥3 months after the attack were included. Only the first or more severely affected eye was included for each patient.

A total of 106 MOGAD patients were included, 50 with bilateral ON. The median age at attack onset was 37 (IQR 22-52) years, with 23% pediatric, 68% female, and 96% White. ODE was present in 88 (81%), with 23/82 (22%) having severe edema. Optic disc hemorrhage was observed in 15 (14%) patients, 14 with concurrent severe ODE and 1 with moderate ODE. Four (4%) patients had additional retinal findings, 3 with concomitant moderate-severe ODE. One patient had ODE and macular star consistent with neuroretinitis, one had scattered hemorrhages with engorged veins consistent with venous stasis retinopathy, one had dilated veins, and one had peripheral retinal hemorrhages. The median Snellen visual acuity (VA) at nadir was 20/200 (IQR 20/30-hand motion), and 86/103 (83%) fully recovered to VA 20/20. Optic disc hemorrhage or retinal findings were not associated with statistically worse VA at nadir or follow-up.

Optic disc hemorrhages and other retinal findings were observed in 16% of acute MOGAD-ON attacks, which were often accompanied by ODE. Given the low rate of residual VA deficits, the association between these findings and outcomes was inconclusive.