Is peripheral vision loss a symptom of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD)?

Peripheral Vision Loss in MOGAD

Peripheral vision loss is not a characteristic feature of MOGAD; instead, patients typically present with central vision loss, often severe, due to optic neuritis affecting the central visual pathways. 1, 2, 3

Typical Visual Manifestations in MOGAD

Central Vision Involvement

• MOGAD-associated optic neuritis characteristically causes severe central visual deficit or complete blindness during acute episodes, with bilateral involvement being common 1, 2, 3
• Patients present with initially severe vision loss rather than peripheral field defects 4, 5
• The optic nerve involvement is typically longitudinally extensive, affecting >50% of the pre-chiasmal optic nerve length or involving the optic chiasm 1

Clinical Presentation Pattern

• Prominent papilledema, papillitis, or optic disc swelling is the hallmark finding on fundoscopy, not peripheral field changes 1, 3
• Perioptic gadolinium enhancement (optic nerve sheath involvement) occurs frequently 1
• Bilateral simultaneous optic neuritis is common, affecting central rather than peripheral vision 1, 6

Why Peripheral Vision is Preserved

Anatomical Considerations

• MOGAD targets the optic nerve in a longitudinally extensive pattern that primarily affects central visual pathways 1
• The disease demonstrates primary demyelination with intralesional complement and IgG deposits affecting the optic nerve proper, not the peripheral retinal nerve fiber layer in isolation 2

Pediatric Evidence

• In pediatric MOGAD patients without optic neuritis history, visual acuity and peripapillary retinal nerve fiber layer (pRNFL) thickness remain unaffected, indicating no subclinical or "silent" peripheral visual system involvement 7
• Children with MOGAD-ON show reduced pRNFL thickness only after documented optic neuritis episodes, not as a progressive peripheral process 7

Important Clinical Caveats

Distinguishing from Other Conditions

• Unlike glaucoma or other conditions causing peripheral vision loss, MOGAD presents with acute central vision loss and optic disc swelling 1, 3
• The absence of peripheral field defects helps distinguish MOGAD from conditions like primary angle-closure disease, which would show peripheral vision loss first 1

Visual Recovery Pattern

• Despite severe initial central vision loss, visual recovery tends to be favorable with good response to steroid treatment, with most patients achieving complete visual recovery 4, 5, 7
• The recovery involves restoration of central vision, not compensation through peripheral fields 6, 7

Monitoring Considerations

• Visual acuity testing (both near and distance) is the primary outcome measure, not peripheral field testing 7
• pRNFL thickness monitoring tracks disease activity in the optic nerve, showing reduction only after ON episodes 7