To investigate the relationship between optical coherence tomography (OCT) and visual pathway volumetric MRI (vMRI) measures in relapsing vs. monophasic myelin oligodendrocyte glycoprotein antibody-associated disease  (MOGAD).

Relapses occur in ~50% of individuals with MOGAD, with optic neuritis (ON), the most frequent attack type. We hypothesize that relapsing MOGAD results in greater damage to visual pathway structures, compared to monophasic course.

We searched our MOGAD database to identify patients with both standardized 3T vMRI and OCT within 1 year. Patients with >1 attack before vMRI were classified as relapsing. Visual pathway vMRI measures included: lateral geniculate nucleus volume (LGN), and occipital lobe grey matter fraction (OGMF). OCT measures included retinal nerve fiber layer (RNFL) and ganglion cell/inner plexiform layer (GCIPL). Linear regression examined differences in vMRI and OCT between groups, controlling for age and sex. Pearson correlations used to relate RNFL/GCIPL with vMRI.

16 MOGAD patients underwent vMRI/OCT. Patient characteristics included median age 21.5 years (range 16-49), female (56%), White (50%), median disease duration 2 years (range 0-24), and relapsing course (44%). Previous attacks included: 88% ON and 38% TM (100% and 57% of relapsing group). Compared to monophasic MOGAD, average RNFL and GCIPL were lower in relapsing patients (β = -16.7; p = 0.06 and β = -12.3; p=0.046, respectively). Patients with relapses also had lower LGN/OGMF, but the differences were not statistically significant (p=0.2 and p=0.4). OD and OS RNFL correlated with LGN volume (0.53, p=0.04; and 0.6, p=0.02) and OGMF (0.50, p=0.07; and 0.71, p < 0.01). OD and OS GCIPL correlated with LGN (0.62, p= 0.02; and 0.88, p<0.001), but not with OGMF (0.39, p= 0.2; and 0.44, p=0.16).

Relapsing MOGAD demonstrated greater visual pathway damage compared to monophasic disease. OCT measures correlates with visual vMRI atrophy measures and may be more sensitive.