Purpose <p>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune disease affecting the central nervous system, frequently manifesting with optic neuritis (ON). Despite often favourable functional visual recovery, structural retinal changes may persist. This prospective study assessed the utility of functional and structural visual outcome measures in paediatric MOGAD.</p> Methods <p>Children with serologically confirmed MOGAD were recruited from across Switzerland, alongside age-matched healthy controls. All participants underwent pattern-reversal visual evoked potentials (VEP; 15′ and 60′ check sizes), spectral-domain optical coherence tomography (OCT), high- and low-contrast distance visual acuity (VA), near VA, and colour vision testing. VEP outcomes were P100 peak times, and OCT outcomes were peripapillary retinal nerve fibre layer (pRNFL) thickness (global, temporal, nasal, and papillomacular bundle (PMB)), macular volume, and central retinal thickness. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis.</p> Results <p>Twelve paediatric MOGAD patients (10.9 ± 3.1&#xa0;years) and twelve age-matched controls (11.5 ± 2.8&#xa0;years) were included. VEP P100 peak times were generally comparable between patients and controls. pRNFL thickness appeared lower in patients than controls. ROC analysis showed excellent to outstanding discrimination for global, PMB, temporal, and nasal pRNFL sectors, both overall and in ON+ and ON– subgroups. VEP P100 peak times exhibited fair or poor discrimination overall, however 15′ check sizes showed excellent discrimination between ON+ and control eyes.</p> Conclusions <p>In our cohort, OCT-derived pRNFL thickness differentiated MOGAD from controls with high accuracy, including in eyes without prior ON. VEPs showed limited utility, supporting OCT as a more sensitive marker of subclinical structural involvement.</p>