Optical coherence tomography angiography (OCTA) could help identify characteristic changes of neuromyelitis optica spectrum disorder (NMOSD) in the retina, according to a recent study in Frontiers in Neuroscience.

“The identified biomarkers and observed alterations may contribute to the early diagnosis and monitoring of NMOSD, potentially offering a time window for intervention and prevention of disease progression,” the authors wrote.

This observational study included a total of 22 patients with a previously confirmed diagnosis of NMOSD and 25 healthy participants that served as the control group from China. All individuals in the sample were females with a mean age of 47.6 and 47.3 years in the NMOSD and control groups, respectively. 

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The first difference the authors found when evaluating the results of the OCTA was shape changes in the deep layers of the retina, present among participants without neuritis optica. This characteristic was most prominent in the foveal avascular zone. 

Regarding vascular patterns, despite not finding statistically significant differences in the microvasculature of patients without optic neuritis vs healthy controls, the NMOSD subgroup with optic neuritis did showcase important microvascular degeneration in the deep and superficial layers of the retina. 

Further subregional investigations confirmed the association between optic neuritis and retinal pathological variation, with the greatest impact in the foveal avascular zone.

These results suggest that the presence of optic neuritis could determine the extent of the pathologic changes in the retina since the nonoptic neuritis group only showcased such variations localized to the foveal avascular zone. In contrast, those with optic neuritis had multiple layers affected. 

Previous publications in the literature have reported that the shape appearance of the foveal avascular zone indicates surrounding edema. Similarly, other articles noted the association of retinal edema with the aquaporin-4 (AQP4) protein, the researchers noted.

“In conclusion, such edema is uncommon in [patients with multiple sclerosis], suggesting that changes in the shape of the foveal avascular zone in the unaffected eye may serve as evidence to distinguish NMOSD from MS,” the authors concluded.


Guo J, Zhang D, Gong Y, et al. Association of retinal microvascular abnormalities and neuromyelitis optica spectrum disorders with optical coherence tomography angiography. Front Neurosci. Published online June 9, 2023. doi:10.3389/fnins.2023.1194661