The authors present a retrospective case review of first presentation isolated cases of optic neuritis tested for aquaporin-4 antibody across two centres over a nine-year period. Exclusion criteria included known diagnosis or other manifestations of neuromyelitis optica spectrum disorder. Two different methods of aquaporin-4 antibody testing were used across the nine years. A total of 106 (120 eyes) patients were included in the study of the 258 identified with optic neuritis. Of those included in the study, 22% were identified to be aquaporin-4 antibody positive. The significant differences in demographic characteristics identified were: (1) the age of onset was higher and (2) a greater proportion of Chinese patients in the group found to be positive. In terms of clinical presentation, those found to be aquaporin-4 antibody positive were less likely to have optic disc swelling, and higher frequency of co-existing autoantibodies. This group was also more likely to be receiving treatments including steroid sparing immunosuppressants and plasma exchange. Despite these findings clinical features may not be useful in selecting patients requiring aquaporin-4 antibody testing. The authors recommend that aquaporin-4 antibody testing be carried out on all first presentation optic neuritis to ensure timely and optimal treatment of neuromyelitis optica spectrum disorder.
Aquaporin-4 antibody testing in isolate optic neuritis
Reviewed by Lauren Hepworth
Should aquaporin-4 antibody test be performed in all patients with isolated optic neuritis?
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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