To determine the relation of visual function tests and optical coherence tomography (OCT) measures to social determinants of health (SDOH) in pediatric-onset multiple sclerosis (POMS).

This was a cross-sectional study of neuro-ophthalmic clinical measures, OCT, and volumetric MRI measures in patients with POMS at a pediatric MS center.  Patients were included if both a volumetric MRI and a ophthalmologic evaluation had been performed. Self-identified race, ethnicity, and current insurance type were collected. SDOH indicators included having Medicaid insurance or self-identifying as a minoritized race/ethnicity such as non-White race or Hispanic/Latino ethnicity (termed “minority status”).

Among 72 patients (144 eyes), median age was 19 years (range 10-27) with a median disease duration of 4 years (0-16) at time of MRI. Minority status was associated with worse high-contrast visual acuity (p=0.006, generalized estimating equation [GEE] models, accounting for age at diagnosis and adjusting for within-patient inter-eye correlations). Non-white race was associated with reduced ganglion cell layer thickness (p<0.001) and worse visual acuity (p=0.002). Having Medicaid insurance was also associated with worse visual acuity (p=0.005) and worse Ishihara color testing (p=0.01). There were no significant differences between SDOH proxies and the percentage of patients on disease modifying therapies.

Structural and functional visual outcomes may be adversely affected among POMS patients with SDOH proxies of social vulnerability. More work is needed to understand how social risk factors can affect visual outcomes in individuals with POMS and how to optimize therapeutic approaches.