From Darkness to Sight: Rapid Recovery in MOG-Associated Optic Neuritis with High-dose Steroid Therapy

Abstract

Myelin Oligodendrocyte Glycoprotein Optic Neuritis (MOG-ON) is a severe inflammatory condition that can cause significant vision loss if untreated. High-dose corticosteroids are known to aid recovery, though the response varies. This case highlights the potential for near-complete visual restoration with early intervention.

A 30-year-old male of Pakistani origin presented with a five-day history of blurred vision and mild left eye pain. His initial visual acuity was 6/12, improving to 6/9 with pinhole correction. Within five days, vision deteriorated to hand movements despite normal routine blood tests. Following neuro-ophthalmology consultation, intravenous methylprednisolone (1g daily for five days) was initiated, followed by an oral taper. Vision improvement began by the third dose, reaching 6/6 with pinhole correction by day five. Color vision, initially 0/17 on Ishihara testing, fully recovered. OCT imaging and visual field testing confirmed significant optic nerve recovery. The patient tested positive for MOG antibodies and was referred to neurology for further care.

This case demonstrates the efficacy of early, high-dose corticosteroid therapy in rapidly restoring vision in severe MOG-related optic neuritis. Prompt intervention, guided by an interdisciplinary approach, can prevent lasting impairment. MOG antibody disease should be considered in optic neuritis cases to ensure timely diagnosis and optimal treatment.