Optical coherence tomography intereye difference metrics to detect optic nerve lesions in children with inflammatory...

The 2024 revisions of the multiple sclerosis (MS) diagnostic criteria emphasize the importance of identifying optic nerve demyelinating lesions. The objective of this study was to validate optical coherence tomography (OCT) intereye difference (IED) metrics for identifying prior optic neuritis (ON) in children and subclinical optic nerve lesions in pediatric MS.

OCT scans from children with MS, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and seronegative acquired demyelinating syndromes (ADS) were analyzed in a cross-sectional study of a nationwide Dutch cohort. Absolute and percentage IED (IEAD, IEPD) in peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thickness were used as indicators of optic nerve demyelination. Diagnostic accuracy was calculated with ROC curve analysis.

The analysis included high-quality optic disc scans of both eyes from 50 children (n=23 MS, n=19 MOGAD, n=8 seronegative ADS) and high-quality macular scans of both eyes from 47 children (n=23 MS, n=15 MOGAD, n=9 seronegative ADS). Overall, pRNFL IED outperformed mGCIPL IED (area under the curve pRNFL: 0.88 [IEAD], 0.90 [IEPD]; mGCIPL: 0.78 [IEAD], 0.74 [IEPD]). Children with bilateral ON demonstrated lower diagnostic value. In pediatric MS, pRNFL IED metrics demonstrated high sensitivity (83.3% for IEAD; 100% for IEPD) and specificity (94.1% for IEAD and IEPD). In children with MS without ON, OCT suggested subclinical optic nerve lesions in up to 22%, often with complementary signs of demyelination.

OCT IED metrics detect prior clinical unilateral ON and may also identify subclinical optic nerve lesions.