Meta-regression of optic nerve imaging and visual outcome in myelin oligodendrocyte glycoprotein antibody optic neuritis

Background: Few predictors of visual outcome after myelin oligodendrocyte glycoprotein (MOG) auto-antibody disease optic neuritis (ON) have been reliably elucidated. We evaluate whether between-study differences in ON neuroimaging regional enhancement features may underlie heterogeneity in reported visual prognosis.

Methods: PROSPERO (CRD42024580123). We systematically review within-study analyses correlating neuroimaging ON findings with visual outcome. Between studies, a meta-regression was conducted using ON segmental and regional inflammation (intraorbital, pre-chiasmal, intra- or post-chiasmal, and longitudinal extension) as predictors of final and change-from-baseline visual acuity (VA; LogMAR).

Results: We identified 26 reports (n = 1197 participants), eleven of which reported VA analyses or data stratified by enhancement region. Despite conflicting reports on the association between final VA and enhancement region, most studies report against this association. Meta-regression across all studies similarly determined that, at the study level, there was no significant association of any ON segment nor region with final or change-from-baseline VA. Risk of bias analysis indicated generally favourable quality across included studies.

Conclusion: Studies with poorer VA outcome did not significantly differ in the proportion of patients with various ON regional enhancement patterns. Future studies stratifying VA by neuroimaging findings with raw data reported are needed.