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

INTRODUCTION: Retinal optical coherence tomography (OCT) is rapidly emerging in the field of inflammatory demyelinating disease of the central nervous system (CNS), but its role in the pediatric population remains unclear. This review aims to provide a comprehensive overview of the clinical utility of OCT in childhood acquired demyelinating syndromes (cADS). METHODS: A systematic literature search was conducted in Embase, Medline, Cochrane Library, Web of Science, and Google Scholar to identify studies reporting OCT findings in cADS. Meta-analyses were performed to compare retinal thickness in multiple sclerosis (MS) eyes with and without prior optic neuritis (ON) to healthy controls. Remaining data were synthesized using an explorative, theme-based approach, focusing on retinal atrophy patterns across cADS subgroups and the utility of OCT as a diagnostic, prognostic, or monitoring tool. RESULTS: Consistent evidence was found for retinal thinning in pediatric acquired demyelinating syndromes, particularly in eyes affected by ON, across multiple OCT metrics. Distinct atrophy patterns were observed in diagnostic subgroups. Retinal thinning was also present in MS eyes without a history of ON, suggesting subclinical optic nerve lesions or CNS neuroaxonal loss transmitted to the retina via trans-synaptic degeneration. While OCT may have prognostic value for visual outcomes, evidence is lacking for broader prognostic utility or for monitoring disease progression or treatment response. CONCLUSIONS: OCT is a valuable diagnostic modality in cADS, particularly for detecting optic nerve lesions. Further research is needed to explore its potential as a biomarker for CNS neurodegeneration and establish its role for prognostication and disease monitoring in cADS.