Comparison of visual outcomes in patients with aquaporin 4 immunoglobulin g-positive, myelin oligodendrocyte glycoprotein immunoglobulin g-positive, and double seronegative optic neuritis following severe optic neuritis

• MOG-IgG-positive optic neuritis showed fastest and most complete visual recovery • AQP4-IgG-positive subtype showed slowest and least favorable recovery • Double seronegative cases exhibited modest but ongoing improvement • Most visual recovery occurred in <3 months • We highlighted longitudinal outcomes, enabling improved optic neuritis management Data regarding idiopathic autoimmune-mediated optic neuritis is limited to visual acuity at specific time points post-treatment, lacking longitudinal comparisons. This study compared visual outcomes in patients with severe visual impairment due to optic neuritis who were aquaporin-4 (AQP4) immunoglobulin G (IgG)-positive, myelin oligodendrocyte glycoprotein (MOG)-IgG-positive, or double seronegative. This retrospective longitudinal study was conducted at the Neurological Institute of Thailand, examining visual outcomes among three patient groups presenting with severe visual impairment—defined as best corrected visual acuity (BCVA) of 20/200 or worse—between June 2020 and May 2023. Visual outcomes were assessed with the “time to good visual recovery”—defined as ≥66.77% improvement in BCVA from post-attack to baseline—and “complete visual recovery”—defined as BCVA returning to baseline. This study included 45 affected eyes of 30 patients, grouped as AQP4-IgG-positive (n=10), MOG-IgG-positive (n=5), and double seronegative (n=30). Median BCVA at onset was 1.7 (logMAR). Using MOG-IgG as a comparator, the hazard ratios for complete visual recovery in the AQP4-IgG-positive and double seronegative groups were 0.158 (p=0.135) and 0.421 (p=0.288), respectively. For good visual recovery, the AQP4-IgG-positive and double seronegative subtypes had hazard ratios of 0.187 (p=0.013) and 0.189 (p=0.005), respectively, compared with the MOG-IgG-positive subtype. Furthermore, all MOG-IgG-positive cases achieved good visual recovery, in contrast to fewer than 50% of the AQP4-IgG-positive and double seronegative subtypes. The MOG-IgG-positive subtype exhibited the best visual prognosis and the shortest recovery time compared to the AQP4-IgG-positive and double seronegative subtypes.