Table 1 Comparison of the immunophysiology and visual phenotype of MOG_{35 − 55}-induced EAE, MS, MOGAD, and NMOSD

Pathophysiology

CD4-positive T-cells, complement activation

CD8-positive T-cells and B-cells, complement activation

CD4-positive T-cells, complement activation

PMN and NK cells, complement activation

Visual Acuity Nadir

Significant vision loss, visual acuity approximately half of baseline

Variable, often mild-moderate vision loss, ~ 35% with 20/200 or worse

Variable, often severe vision loss, ~ 70% with 20/200 or worse

Severe vision loss, ~ 85% worse than 20/200

Visual Recovery

Mild recovery, not back to baseline

Good, 95% with 20/40 or better

Good, but variable with 80% recover to 20/30 or better

Poor recovery, 50–70% with < 20/200 in at least one eye

MRI Ocular Findings

Unilateral or bilateral ON, short to moderate length segments of demyelination seen, spares retrobulbar space

Almost always unilateral ON, short segment enhancement of anterior optic nerve, spares retrobulbar space

Bilateral in 30–40% of cases, longitudinally extensive lesions of the anterior optic nerves, includes retrobulbar space

Bilateral in 20–30% of cases, enhancement at optic chiasm, sometimes involvement of posterior optic tracts

Histology

Short segments of demyelination, axonal degeneration, inflammation with macrophage and T-cell infiltration

Confluent areas of demyelination, inflammation present with macrophage, B-cell, and T-cell infiltrate at lesion borders/perivascular spaces, loss of oligodendrocytes

Multifocal perivenous inflammation and demyelination with B-cells, CD4 T-cells, and macrophages, preservation of oligodendrocytes

Monocyte and T-cell infiltration with diffuse demyelination secondary to astrocytopathy, loss of oligodendrocytes, RGC axon loss

MRI Spine Findings

Longitudinally extensive demyelination seen

Multiple short, focal areas of enhancement (peripheral white matter)

Longitudinally extensive myelitis in cervical and thoracic spine (gray matter only), conus involvement

Longitudinally extensive myelitis in cervical and thoracic spine (white and gray matter involvement)

OCT

Moderate RNFL thickening at day 14–21, followed by GCIPL thinning

Mild RNFL increase acutely, GCIPL thinning in following weeks

Significant RNFL thickening, early GCIPL loss

Variable RNFL thickening, profound GCIPL loss

Fundus

Moderate edema

Normal to mild optic disc edema (35%)

Moderate to severe disc edema (85%)

Variable, milder if present