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

Background Optic neuritis (ON) is the most prevalent manifestation of pediatric multiple sclerosis (MS ped ) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD ped ) in children > 6 years. In this study, we investigated retinal atrophy patterns and diagnostic accuracy of optical coherence tomography (OCT) in differentiating between both diseases after the first ON episode. Methods Patients were retrospectively identified in eight tertial referral centers. OCT, VEP and high/low-contrast visual acuity (HCVA/LCVA) have been investigated > 6 months after the first ON. Prevalence of pathological OCT findings was identified based on data of 144 age-matched healthy controls. Results Thirteen MOGAD ped (10.7 ± 4.2 years, F:M 8:5, 21 ON eyes) and 21 MS ped (14.3 ± 2.4 years, F:M 19:2, 24 ON eyes) patients were recruited. We observed a significantly more profound atrophy of both peripapillary and macular retinal nerve fiber layer in MOGAD ped compared to MS ped (pRNFL global: 68.2 ± 16.9 vs. 89.4 ± 12.3 µm, p