Characteristic retinal atrophy pattern allows differentiation between pediatric MOGAD and MS after a single optic...

Area of Science:

• Ophthalmology
• Neurology
• Pediatrics

Background:

• Optic neuritis (ON) is a primary manifestation of pediatric multiple sclerosis (MS^ped) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD^ped) in children over 6 years old.
• Differentiating between MOGAD^ped and MS^ped is crucial for appropriate treatment and prognosis.
• Optical coherence tomography (OCT) is a valuable tool for assessing retinal changes.

Purpose of the Study:

• To investigate retinal atrophy patterns in children with MOGAD^ped and MS^ped after their first ON episode.
• To evaluate the diagnostic accuracy of OCT in differentiating between MOGAD^ped and MS^ped.
• To compare the sensitivity of OCT and visual evoked potentials (VEP) in identifying ON in MOGAD^ped.

Main Methods:

• Retrospective analysis of pediatric patients diagnosed with MOGAD^ped or MS^ped from eight referral centers.
• OCT, VEP, and visual acuity (HCVA/LCVA) were assessed more than 6 months after the first ON episode.
• Prevalence of pathological OCT findings was determined by comparing patient data with 144 age-matched healthy controls.

Main Results:

• MOGAD^ped patients exhibited significantly more profound global peripapillary and macular retinal nerve fiber layer atrophy compared to MS^ped patients.
• MOGAD^ped showed global atrophy across all peripapillary segments, whereas MS^ped primarily displayed temporal thinning.
• Nasal pRNFL measurements provided the highest diagnostic accuracy (AUC=0.902) for differentiating MOGAD^ped from MS^ped. OCT was more sensitive than VEP in detecting ON in MOGAD^ped (90% vs. 14%).

Conclusions:

• The first episode of MOGAD-ON leads to more severe global peripapillary atrophy than MS-ON, which is characterized by predominantly temporal thinning.
• Nasal pRNFL measurements using OCT offer high accuracy in distinguishing between MOGAD^ped and MS^ped.
• OCT imaging provides significant additional diagnostic value for children presenting with optic neuritis.