Clinical Characteristics and Visual Outcomes of Optic Neuritis in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a neuro-immunological disorder that can cause optic neuritis (ON) and significant visual impairment. Our objective was to investigate clinical characteristics and visual outcomes in children with MOGAD-ON. METHODS: Retrospective cohort study of MOG-IgG-positive children (onset age 18 years and younger) meeting 2023 international MOGAD panel criteria who presented with ON and received neuro-ophthalmic care between 2003 and 2023 at 3 academic centers in Northern California was conducted. We captured demographic and clinical characteristics, disease course, and presenting MOG-IgG titers through chart review. Ophthalmic metrics, including logarithmic minimum angle of resolution best-corrected visual acuity (logMAR BCVA), retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer thicknesses, and automated visual field mean deviation (AVF MD) at diagnosis, 1-month, 6-month, 1-year, and final (2+ years) visits, were obtained. RESULTS: This study included 49 ON-affected eyes of 29 patients (20 with bilateral involvement), with 19 (66%) being female. The median age at first diagnosis was 9 years (range 1-18). The median follow-up was 40 months (0-119). Age younger than 8 years at MOGAD onset was predictive of recurrent ON (β1=-1.61, P = 0.03). LogMAR BCVA improved from 1.4 at diagnosis to 0.2 at 1 month and 0.07 at the final visit (P < 0.0001). In total, 29 eyes (59%) of 22 patients (76%) achieved complete visual recovery (BCVA LogMAR 0). RNFL thickness decreased from mean 130 µm at diagnosis to 6 months (65 µm, P < 0.05). Average AVF MD improved from -12.8 dB at diagnosis to -5.4 dB at the final visit (P = 0.02). Higher presenting MOG-IgG titers were associated with worse presenting visual fields (r = -0.96, P = 0.04). CONCLUSIONS: Children with MOGAD-associated ON often return to normal visual acuity despite significant optic atrophy. Most RNFL thinning occurs in the first 6 months but continues beyond 2 years after MOGAD onset. Younger children were at greater risk of ON relapse. A prospective longitudinal study on pediatric MOGAD-ON is warranted to validate these findings and identify biomarkers for visual outcome prediction.