Children with multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein (MOG)-associated syndromes exhibit changes in the retinal nerve fiber layer thickness (RNFL) and ganglion cell inner plexiform layer thickness (GCIPL), but knowledge about abnormalities in the optic nerve head (ONH) morphology in these groups is lacking. Previous studies have characterized deformations of the ONH structures associated with glaucoma and increased raised intracranial pressure and others demonstrated the utility of the assessment of these 3D parameters in the management of adults with aquaporin-4-related NMOSD and acute optic neuritis. No information regarding the utility of these measures in childhood demyelinating syndromes is available.
To compare 3D ONH characteristics of pediatric multiple sclerosis and MOG-associated syndromes to healthy controls (HC).
Standardized OCT data (Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA)) were collected on HC [n=27(16 female); median age at OCT of 15.0 years (13.7-16.3)], pediatric MS patients [n=17(11 female), median age at diagnosis of 16.9 years(15.4-18.4); median disease duration of 2.6 years(0.2-5.4)] and children with MOG-related disorders [ n=13( 11 female); median age at diagnosis of 11.5 years (7.3-15.7), median disease duration of 1.7 years(0.4-3)]. ONH parameters (total ONH volume (TV), Bruch’s membrane opening (BMO), region volume (BMO-Vol), and BMO minimal rim width (BMO-MRW)) were computed by triangulated 3D surface reconstruction. Mean peripapillary RNFL and GCIPL were derived from manufacturer’s fully-automated segmentation software, and results were reviewed with manual correction where necessary. Multivariable mixed effects models were used to model the 5 OCT parameters between groups, accounting for age at OCT, eye-specific number of optic neuritis episodes, and a subject-specific random intercept. Results were Bonferroni adjusted for multiple comparisons (p = 0.01).
MS patients showed lower ONH TV (-.241, SE.073; p=.002), BMO-Vol (-.217, SE.083; p=.012), and BMO-MRW (-0.42 dMRW, SE.014; p=.004) compared to HC. ONH parameters were not different in MOG patients compared to controls. Neither RNFL nor GCIPL were significantly different between HC and MS. GCIPL was lower in MOG than HC (-7.9, SE 3.045; p.012).
Our analysis showed ONH volume loss in pediatric MS despite no significant differences in RNFL or GCIPL compared to HC. These changes were not observed in MOG patients. ONH analysis may therefore be superior to RNFL and GCIPL in detecting anterior visual pathway injury in children with MS early in the disease course. Larger studies are needed to confirm these associations.