In this SRNA "Ask the Expert" episode moderated by Krissy Dilger, Dr. John Chen of the Mayo Clinic answered audience questions about MOG antibody disease (MOGAD). He discussed diagnosis and the importance of titers and live cell-based assays given possible false positives [00:02:42]. Dr. Chen reviewed acute management with early high-dose steroids, prolonged tapers, and escalation to plasma exchange for severe or steroid-refractory attacks, as well as evolving long-term options including IVIG/subcutaneous IG and IL-6 blockade [00:04:14]. Audience questions covered relapse prediction, vision recovery timelines, fatigue, pregnancy, heredity, symptom interpretation, and whether to stop immunotherapy when antibodies become undetectable [00:12:13]. Finally, Dr. Chen described current and upcoming research, including a trial that is currently enrolling participants, and future prospects for optic nerve regeneration while cautioning against unproven stem cell clinics [00:41:37].

John J. Chen, MD, PhD attended the University of Virginia for his undergraduate and combined MD/PhD degrees and completed his Ophthalmology residency and Neuro-Ophthalmology fellowship training at the University of Iowa. He then took a position at the Mayo Clinic in 2014 where he specializes in Neuro-Ophthalmology. Currently, he serves as a Consultant and Professor of Ophthalmology and Neurology, and Neuro-Ophthalmology Fellowship Director at the Mayo Clinic.

Among Dr. Chen’s awards and honors are the AAO Senior Achievement Award, Top Doctors in Minnesota, the Heed Fellowship, Real World Ophthalmology Inspiring Academic Leader Award, Ophthalmology Teacher of the Year Award four times leading to induction to the Educators Hall of Fame, and the Mayo Clinic Distinguished Educator Award – awarded to the top educator at Mayo Clinic in Rochester. He is an Associate Editor for Ophthalmology and the Journal of Neuro-Ophthalmology, has authored more than 250 peer-reviewed publications, and focuses his research on ophthalmic imaging, idiopathic intracranial hypertension, and optic neuritis, particularly NMOSD and MOG antibody–associated disease.

00:00 Welcome and Introductions

01:08 What Is MOGAD?

02:42 Causes and Triggers

03:23 How MOGAD Is Diagnosed

04:14 Acute Attack Treatments

06:35 Steroid Side Effects

08:13 Testing During Treatment

09:09 Long Term Therapies

12:13 Interpreting MOG Positivity

16:51 Eye Symptoms and Vision Fluctuations

20:12 Antibody Titers and Severity

21:19 Relapse Risk After First Attack

23:09 Seizures and Encephalitis

24:17 Vision Recovery After Optic Neuritis

25:13 Acute Treatment Window

25:57 Hereditary Risk Questions

26:35 Stopping Azathioprine Safely

29:56 Managing Post Attack Pain

30:16 Steroids IVIG and Plasma Exchange

32:08 Infections as Triggers

33:01 Retesting MOG Antibodies

35:01 Fatigue and Workup

36:23 Prognosis and Life Expectancy

37:45 Tinnitus and Brain Pressure

39:05 Pediatric and Pregnancy Concerns

41:37 Trials and Future Regeneration

46:05 Research Resources and Wrap Up