Abstract Details

Title Inter-eye RNFL Asymmetry as a Biomarker of Remote Optic Neuritis in Pediatric-onset Multiple Sclerosis

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) S18 - Neuro-ophthalmology/Neuro-otology (5:18 PM-5:30 PM)

Poster/Presentation
Number 010

Objective To find the optimal retinal nerve fiber layer (RNFL) thickness difference threshold as a biomarker of prior unilateral optic neuritis (ON) in pediatric-onset multiple sclerosis (POMS) and examine its relationship with global and regional brain volumes.

Background Optical coherence tomography (OCT) offers a rapid, noninvasive means to detect axonal injury. Adult multiple sclerosis criteria use an RNFL inter-eye difference (IOD) ≥ 5 µm to indicate prior ON, but pediatric eyes are more symmetric and may require lower thresholds. Establishing pediatric-specific cutoffs and linking them to central nervous system structural integrity could enhance early diagnosis and prognostication.

Design/Methods In a cross-sectional case-control study, 20 POMS patients with prior unilateral ON (mean onset 15.1 y, exam 20.6 y) and 20 age-matched controls underwent bilateral spectral-domain OCT. Global RNFL thickness, inter-eye difference, and best-corrected visual acuity were measured. Whole-brain, gray-matter, and cerebellar volumes were derived from MRI. Group comparisons used Mann–Whitney U tests; correlations used Pearson r. ROC analysis with Youden’s J identified the optimal IOD threshold.

Results ON-affected eyes showed thinner RNFL versus controls (82.9 ± 21.7 µm vs 99.8 ± 9.8 µm, p = 0.0024). Median RNFL IOD was 8.5 µm in POMS vs 2.5 µm in controls (p = 0.0024). ROC analysis (AUC = 0.78) identified 4 µm as the optimal discrimination threshold. RNFL IOD correlated with inter-eye visual acuity difference (r = 0.41, p = 0.008) and inversely with whole-brain (p = 0.02), gray-matter (p = 0.03), and cerebellar volumes (p = 0.04).

Conclusions A 4 µm RNFL IOD reliably identifies prior ON in pediatric MS and associates with reduced brain, gray-matter, and cerebellar volumes, supporting its value as a marker of both localized and global neuroaxonal loss. Integrating OCT-based asymmetry metrics with volumetric MRI may improve early diagnosis and risk stratification in pediatric MS.

Authors/Disclosures
Joshua Rodriguez PRESENTER	Mr. Rodriguez has nothing to disclose.
Sydney Chatfield, MD	Dr. Chatfield has nothing to disclose.
Rachel Kenney	Rachel Kenney has received personal compensation for serving as an employee of Optum. Rachel Kenney has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Minton ��ɫ�� LLC.
Laura J. Balcer, MD, MSCE, FAAN (NYU Grossman School of Medicine)	An immediate family member of Dr. Balcer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Children's Hospital of Philadelphia.
Scott Grossman, MD (New York University, Langone Health)	Dr. Grossman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acuta Pharmaceuticals.
Steven Galetta, MD, FAAN (NYU Langone Medical Center)	Dr. Galetta has nothing to disclose.
Kimberly O'Neill, MD	Dr. O'Neill has nothing to disclose.

��ɫ����

��ɫ����

��ɫ��

��ɫ��