Mayo Clinic Ophthalmology Podcast Optic Neuritis with Dr. John Chen
Apr 19, 2023
John Chen, neuro-ophthalmologist and professor known for work on optic neuritis, NMO, and MOGAD. He traces ONTT history and explains why many NMO/MOG cases were missed. He outlines population rates, biomarkers like aquaporin-4 and MOG testing, and clinical/MRI clues that distinguish MS, NMO, and MOG. He also covers initial workup, referral advice, and upcoming trials.
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ONTT Limits And Modern Gaps
- The Optic Neuritis Treatment Trial (ONTT) sped recovery with IV corticosteroids but didn't change long-term outcomes for typical MS-related optic neuritis.
- ONTT lacks guidance for atypical causes like NMO and MOGAD, so our approach to those has evolved considerably.
True Community Frequencies
- Population data show about 50% of optic neuritis cases are MS, ~3% NMO, and ~5–6% MOG, so atypical causes make up roughly 8–9% of cases.
- These atypical causes are less common but frequent enough to warrant clinical awareness beyond referral-center bias.
Mayo's Role In Defining NMO and MOGAD
- Mayo Clinic researchers discovered the aquaporin-4 antibody, proving NMO is distinct from MS and establishing a diagnostic biomarker.
- Similar cell-based assays later enabled reliable detection of MOG antibodies and clarified MOGAD as its own entity.