A systematic review of the clinical utility of retinal optical coherence tomography in childhood acquired demyelinating syndromes

Optical coherence tomography (OCT) reveals marked retinal atrophy after optic neuritis but also in clinically unaffected eyes of children with pediatric-onset multiple sclerosis (POMS), to a degree comparable to that seen in adults-onset multiple sclerosis (AOMS). OCT can be a valuable tool in the diagnostic work-up of pediatric optic neuritis (ON), particularly for confirming remote ON. OCT's full clinical potential in pediatric ON seems underutilized, with literature suggesting possible roles in differentiating specific etiologies and informing on visual recovery. Despite limited data, OCT might be capable of detecting subclinical optic nerve involvement. OCT likely captures neuroaxonal loss in POMS, consistent with trans-synaptic degeneration which is a wellestablished phenomenon in adults with demyelinating disease, though pediatric evidence is scarce. Evidence supporting OCT as a longitudinal biomarker in cADS is very limited, leaving its utility in disease monitoring and prognostication uncertain.