NEURO-OPHTHALMOLOGY: Edited by Dean M. CestariUpdate on pediatric optic neuritisLock, Jane H.a; Newman, Nancy J.a,b,c; Biousse, Valériea,b; Peragallo, Jason H.a,d Author Information aDepartment of Ophthalmology bDepartment of Neurology cDepartment of Neurological Surgery dDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA Correspondence to Dr Jason H. Peragallo, MD, Department of Ophthalmology; Department of Pediatrics, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA 30322, USA. Tel: +1 404 778 5360; fax: +1 404 778 4849; e-mail: [email protected] Current Opinion in Ophthalmology: November 2019 - Volume 30 - Issue 6 - p 418-425 doi: 10.1097/ICU.0000000000000607 Buy Metrics Abstract Purpose of review To summarize recent developments in the classification, investigation and management of pediatric optic neuritis (PON). Recent findings A recent surge in interest surrounding antibodies to myelin oligodendrocyte glycoprotein antibody (MOG-Ab) has instigated a paradigm shift in our assessment of children with PON. This serological marker is associated with a broad spectrum of demyelinating syndromes that are clinically and radiologically distinct from multiple sclerosis (MS) and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). Optic neuritis is the most common presenting phenotype of MOG-Ab positive-associated disease (MOG+AD). MOG-Ab seropositivity is much more common in the pediatric population and it predicts a better prognosis than MS or AQP4+NMOSD, except in the subset that exhibit a recurrent phenotype. Summary A better grasp of MOG+AD features and its natural history has facilitated more accurate risk stratification of children after a presenting episode of PON. Consequently, the initial investigation of PON has broadened to include serology, along with neuroimaging and cerebrospinal fluid analysis. Acute treatment of PON and chronic immunotherapy is also becoming better tailored to the suspected or confirmed diagnoses of MS, AQP4+NMOSD and MOG+AD. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.