Laser-Assisted In Situ Keratomileusis Surgery on a Patient with Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease or Neuromyelitis Optica Spectrum Disorder
Table 2
Suggested questions and testing for patients with neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease to include in a thorough ophthalmologic evaluation.
Patient history
Do you have any history of eye pain? Have you ever been diagnosed with optic neuritis? How many recurrences of optic neuritis, if any? When was the last episode? Has anything triggered an episode (e.g., severe allergic reaction, surgery, trauma, etc.)? Are you currently on steroids or any long-term immunosuppressive agents? Do you have any history of dry eyes or recurrent corneal erosions? Do you have any history of eye infections (especially bacterial or viral corneal infection)? Have you ever had an episode of facial palsy, double vision, or nystagmus? Do you have any lasting visual deficits? Do you have neuropathic pain?
Testing
Imaging
Review MRI brain/orbits with contrast to determine the extent of optic nerve involvement. Chiasmal involvement, longitudinally extensive optic nerve enhancement, and/or bilateral optic nerve involvement point to ON of NMOSD or MOGAD versus MS-associated ON.1,2 Review OCT optic nerve to determine the extent of optic nerve damage. Markedly reduced peripapillary nerve fiber layer thickness is commonly seen following ON of NMOSD and MOGAD.1,2
Current visual quality
Comprehensive dilated ophthalmic exam Pelli-Robson contrast sensitivity chart Red desaturation test, Ishihara color plate Automated perimetry testing
Determine the seropositivity with a cell-based assay to detect AQP4-IgG or MOG-IgG in serum. Titers do not reliably predict remission.2 Spontaneous nystagmus testing Comprehensive neurologic exam to determine the extent of neurologic deficits (especially cranial nerves 2, 3, 5, 7)
