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Patients with initial manifestation &lt;18 years were included in the pediatric (MOGAD\n                      <jats:sup>ped<\/jats:sup>\n                      ) cohort and patients with \u226518 years in the adult (MOGAD\n                      <jats:sup>adult<\/jats:sup>\n                      ) cohort. For patients with MOGAD ON, examinations at least \u22656 months after ON onset were included in the analyses. Using spectral domain optical coherence tomography (SD-OCT), we acquired peripapillary retinal nerve fiber layer thickness (pRNFL) and volumes of combined ganglion cell and inner plexiform layer (GCIPL). High- and 2.5% low-contrast visual acuity (HCVA, LCVA) and visual-evoked potentials (VEP) were obtained.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty MOGAD\n                      <jats:sup>ped<\/jats:sup>\n                      (10.3\u00b13.7 years, 30 MOGAD ON eyes) and 39 MOGAD\n                      <jats:sup>adult<\/jats:sup>\n                      (34.9\u00b111.6 years, 42 MOGAD ON eyes) patients were included. The average number of ON episodes per ON eye was similar in both groups (1.8\u00b11.3 and 2.0\u00b11.7). In both pediatric and adult MOGAD, ON led to pronounced neuroaxonal retinal atrophy (pRNFL: 63.1\u00b118.7 and 64.3\u00b122.9 \u03bcm; GCIPL: 0.42\u00b10.09 and 0.44\u00b10.13 mm\n                      <jats:sup>3<\/jats:sup>\n                      , respectively) and moderate delay of the VEP latencies (117.9\u00b110.7 and 118.0\u00b114.5 ms). In contrast, visual acuity was substantially better in children (HCVA: 51.4\u00b19.3 vs. 35.0\u00b120.6 raw letters,\n                      <jats:italic>p<\/jats:italic>\n                      =0.001; LCVA: 22.8\u00b114.6 vs. 13.5\u00b116.4,\n                      <jats:italic>p<\/jats:italic>\n                      =0.028). Complete visual recovery (HCVA-logMAR 0.0) occurred in 73.3% of MOGAD\n                      <jats:sup>ped<\/jats:sup>\n                      and 31% MOGAD\n                      <jats:sup>adults<\/jats:sup>\n                      ON eyes, while 3.3% and 31% demonstrated moderate to severe (logMAR &gt; 0.5) visual impairment. Independent of retinal atrophy, age at ON onset significantly correlated with visual outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pediatric MOGAD ON showed better visual recovery than adult MOGAD ON despite profound and almost identical neuroaxonal retinal atrophy. Age-related cortical neuroplasticity may account for the substantial discrepancy between structural changes and functional outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12974-021-02160-9","type":"journal-article","created":{"date-parts":[[2021,5,29]],"date-time":"2021-05-29T10:08:11Z","timestamp":1622282891000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Age-dependent favorable visual recovery despite significant retinal atrophy in pediatric MOGAD: how much retina do you really need to see well?"],"prefix":"10.1186","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4386-1340","authenticated-orcid":false,"given":"Joachim","family":"Havla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thivya","family":"Pakeerathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Schwake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Kleiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Felipe-Ruci\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie C.","family":"Joachim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelie S.","family":"Lotz-Havla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"K\u00fcmpfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Krumbholz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva M.","family":"Wendel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Reindl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Thiels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"L\u00fccke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Hellwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Gold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Rostasy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Ayzenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,29]]},"reference":[{"issue":"1","key":"2160_CR1","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s12974-018-1144-2","volume":"15","author":"S Jarius","year":"2018","unstructured":"Jarius S, Paul F, Aktas O, Asgari N, Dale RC, de Seze J, et al. 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The local ethics committees approved the study protocol in accordance with the Declaration of Helsinki (1964) in its currently applicable version.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"J. Havla reports grants for OCT research from the Friedrich-Baur-Stiftung and Merck; personal fees and non-financial support from Celgene, Merck, Alexion, Novartis, Roche, Santhera, Biogen, Heidelberg Engineering, and Sanofi Genzyme; and non-financial support of the Guthy-Jackson Charitable Foundation, all outside the submitted work.T. Pakeerathan has no conflicts of interest.C. Schwake has no conflicts of interest.J.L. Bennett reports payment for study design\/consultation from MedImmune\/Viela Bio; personal fees from AbbVie, Alexion, Chugai, Clene Nanomedicine, Mitsubishi-Tanabe, Reistone Bio, Genentech, and Roche; grants and personal fees from Novartis, Mallinckrodt, and the National Institutes of Health; and has a patent for Aquaporumab issued.I. Kleiter has received speaker honoraria or travel funding from Alexion, Biogen, Novartis, Merck, Mylan, Sanofi Genzyme, and Roche; travel funding from the Guthy-Jackson Charitable Foundation; and consulted for Alexion, Biogen, Celgene, Chugai, IQVIA, Novartis, Merck, and Roche.A. Felipe-Ruci\u00e1n has no conflicts of interest.S.C. Joachim received travel funding and\/or speaker honoraria from Bayer, Novartis, and Roche and received research support from Bayer, Novartis, Roche, and Ursapharm.A. S.\u00a0Lotz-Havla has received travel expenses from BioMarin.T. K\u00fcmpfel received speaker and\/or consultation honoraria from Bayer Healthcare, Merck, Novartis Pharma, Roche Pharma, and Biogen as well as grant support from Novartis.M. Krumbholz received travel funding and\/or speaker honoraria from Merck, Novartis, and Roche and research support from Merck.E. Wendel has nothing to declare.M. Reindl (the University Hospital and Medical University of Innsbruck (Austria); employer of M. Reindl) receives payments for antibody assays (MOG, AQP4, and other autoantibodies) and for antibody validation experiments organized by Euroimmun and research grants from Euroimmun and Roche.C. Thiels has no conflicts of interest.T. L\u00fccke has no conflicts of interest.K. Hellwig has received travel grants from Biogen, Novartis, and Merck and received speaker and research honoraria from Biogen Idec Germany, Teva, Sanofi Genzyme, Novartis, Bayer Healthcare, Merck Serono, and RocheR. Gold received speaker\u2019s and board honoraria from Baxter, Bayer Schering, Biogen Idec, CLB Behring, Genzyme, Merck Serono, Novartis, Stendhal, Talecris, and Teva. His department received grant support from Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, and Teva. All are not related to the content of this manuscript.K. Rostasy has no conflict of interest related to this article.I. Ayzenberg has received travel grants from Biogen Idec and Guthy-Jackson Charitable Foundation, served on scientific advisory boards for Roche and Alexion, and received research support from Diamed, not related to this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"121"}}