Morning glory disc anomaly in children: Optical coherence tomography as a prognostic and management tool

Abstract Body:

Purpose: To investigate the utility of Optical Coherence Tomography (OCT) as a prognostic screening tool in children with Morning Glory Disc Anomaly (MGDA) through the correlation of macular OCT findings with visual acuity outcomes.

Study Design: A retrospective, observational case series of MGDA patients over a 17-year period (January 1st, 2000 to June 1st, 2017) at the Hospital for Sick Children.

Methods: Approval from our institutional Research Ethics Board was obtained. A database search was performed for all patients diagnosed with MGDA. Inclusion criteria were a) confirmed MGDA diagnosis using fundus photos, b) having a high-quality macular OCT, c) reliable visual acuity measurement, and d) no history of retinal detachment. Visual acuity was then compared to the level of foveal involvement observed on macular OCT.

Results: Five patients (six eyes) met our inclusion criteria. Visual acuities ranged from 20/20 to light perception (LP). Macular OCT revealed a spectrum of foveal involvement correlating with the level of visual acuity (20/20, 20/32, 20/80, 20/160, 20/300, and LP). The fovea was completely unaffected with 20/20 acuity. There was progressively greater involvement of the outer retinal layer by the MGDA excavation for each level of reducing acuity until no fovea could be identified with LP vision.

Conclusions: In congenital ocular abnormalities, it can be difficult to predict visual outcomes, and occlusion therapy is often attempted to optimize visual outcomes in cases of suspected amblyopia. We propose the use of OCT as a prognostic indicator to guide amblyopia treatment since anatomical integrity of the fovea correlates with visual outcomes rather than the diagnosis of MGDA itself.