OCT as an Emerging Diagnostic Tool in Pediatric-Onset Multiple Sclerosis: Scott Grossman, MD

WATCH TIME: 8 minutes | Captions are auto-generated and may contain errors.

"OCT is a wonderful technology in that it's simple, easy to obtain, essentially the same no matter where it's obtained, as long as it's on the same platform, and very reliable."

Multiple sclerosis (MS) diagnostic approaches have continued to evolve following the 2024 revisions to the McDonald criteria, which now recognizes the optic nerve as a fifth anatomic location for demonstrating dissemination in space. The revisions also incorporated multimodal assessments, including optical coherence tomography (OCT) and visual evoked potentials, to support evidence of optic nerve involvement in patients with suspected MS.¹ These updates were intended to improve diagnostic sensitivity, particularly in patients presenting with optic neuritis or subclinical optic nerve injury.

Recent research has focused on how OCT-derived retinal nerve fiber layer (RNFL) inter-eye differences may help identify prior optic neuritis in both symptomatic and asymptomatic patients with MS.² Although adult cohorts have validated specific inter-eye RNFL thresholds incorporated into the updated criteria, emerging data presented at the recently concluded 2026 American Academy of Neurology (AAN) Annual Meeting, held April 18–22 in Chicago, Illinois, explored whether similar OCT-based measures could be applied to pediatric-onset MS populations, where normative OCT data remain more limited.³

In an interview with NeurologyLive^® at AAN 2026, study author Scott Grossman, MD, assistant professor of neurology and ophthalmology at NYU Grossman School of Medicine, discussed findings from a single-center study presented evaluating OCT-derived inter-eye RNFL differences in pediatric-onset MS. During the conversation, he spoke about the potential role of OCT in supporting earlier recognition of optic nerve involvement and the clinical implications of incorporating OCT into diagnostic workflows for pediatric demyelinating disease. In addition, Grossman discussed future directions for establishing normative pediatric OCT datasets.

Editor’s Notes: Grossman has disclosed that he has received personal compensation for serving as a Consultant for Acuta Pharmaceuticals.

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REFERENCES
1. Montalban X, Lebrun-Frénay C, Oh J, et al. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria. Lancet Neurol. 2025;24(10):850-865. doi:10.1016/S1474-4422(25)00270-4
2. Saidha S, Green AJ, Leocani L, et al. The use of optical coherence tomography and visual evoked potentials in the 2024 McDonald diagnostic criteria for multiple sclerosis. Lancet Neurol. 2025;24(10):880-892. doi:10.1016/S1474-4422(25)00275-3
3. Rodriguez J, Chatfield S, Kenney R, et al. Inter-eye RNFL Asymmetry as a Biomarker of Remote Optic Neuritis in Pediatric-onset Multiple Sclerosis. Presented at: 2026 AAN Annual Meeting; April 18-22; Chicago, Illinois.