Racial Differences in Visual Outcomes in Patients with Nmosd and Mogad

Background: Neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody disorder (MOGAD), and multiple sclerosis (MS) are demyelinating diseases that cause optic neuritis (ON), resulting in painful loss of central vision, peripheral vision, contrast sensitivity, and color vision (1). Studies have shown that Blacks with MS have accelerated retinal nerve fiber loss, ganglion cell/inner plexiform layer thinning, and have greater impaired vision (2). Hispanics, while having a lower risk for MS (3), develop MS at a younger age (4) and more often present with ON than Whites (5).

Objectives: The objective of this study is to determine if these health disparities also exist in NMOSD and MOGAD and if these differences stem from social disadvantage.

Methods: A retrospective study was conducted with patients (N=62) at Keck Hospital and LA County hospital who were diagnosed with NMOSD or MOGAD. Patient demographics and variables describing visual function (eye exam, color plate testing, and ocular coherence tomography) were collected within a 5-year disease history. Household median income and Social Deprivation Index (SDI) were collected using zip code tabulation areas from the 2015-2019 American Community Survey and the Robert Graham Center. We analyzed the visual outcomes across race at 3 visits:

1. Baseline: Earliest documented visit at least 6 months after an ON attack.
2. Most Recent: Most recent visit.
3. Acute Attack: Within a month of the first documented ON attack.

For Baseline and Most Recent, both eyes were analyzed using mixed-effects models. For Acute Attack, the eye with worse visual acuity was analyzed.

Results: Hispanics were more likely to have public health insurance than other racial groups (χ²(3)=12.8, p=0.007). Black and Hispanic patients were more likely to have a lower median income and SDI compared to Whites and Asians (p=0.007, p=0.004). Serotype was associated with visual acuity in Baseline (p=0.012) and Most Recent (p=0.014). In Acute Attack, Hispanics were more likely to report eye pain compared to Whites and Asians (p=0.005). At all visits, visual acuity was not significantly associated with race, SDI, or median income.

Conclusions: Disease serotype was the only factor significantly associated with visual acuity, reaffirming that diagnosis is a better predictor of visual outcomes than race. Because Hispanics were more likely to report eye pain during an ON attack, eye pain may be a useful clinical indicator of relapse among Hispanics.