Ganglion cell unveils hidden optic chiasmopathy in AQP4+ neuromyelitis optica spectrum disorder

Ganglion cell unveils hidden optic chiasmopathy in AQP4+ neuromyelitis optica spectrum disorderA 40-year-old woman with AQP4-NMOSD was referred to determine previous visual involvement.She could not recall any vision loss or pain with eye movements.OCT revealed binasal thinning on ganglion cell analysis, highly specific for optic chiasmopathy (Fig. A), with corresponding bitemporal thinning of the retinal nerve fiber layer (RNFL) (Fig. B).Findings of the examination and Humphrey 24-2 SITA-Fast visual fields were normal (Fig. C).Magnetic resonance imaging of the brain showed multiple juxtacortical deep and periventricular T2 fluid-attenuated inversion recovery (FLAIR) hyperintense white matter lesions but no chiasmal pathology (Fig. D).This case highlights the value of OCT in documenting previous visual pathway involvement in demyelinating diseases and establishing dissemination in space.