Reliability and Recommended Settings for Pediatric Circumpapillary Retinal Nerve Fiber Layer Imaging Using Hand-Held Optical Coherence Tomography.
Shah Sonal D, Haq Adnaan, Toufeeq Shafak, Tu Zhanhan, Edawaji Budor, Abbott Joseph, Gottlob Irene, Proudlock Frank A
AI Summary
Hand-held OCT can reliably measure retinal nerve fiber layer thickness in awake children, proving feasible for glaucoma assessment, with optimal imaging at 6° from the optic nerve.
Abstract
Purpose
To investigate feasibility and reliability of 3-dimensional full circumpapillary retinal nerve fiber layer (cpRNFL) analysis in children, with and without glaucoma, without the use of sedation and to recommend a protocol for hand-held optical coherence tomography use.
Methods
A cohort of pediatric glaucoma patients and normal children were imaged with hand-held optical coherence tomography to assess the feasibility of obtaining full cpRNFL. Two consecutive scans were acquired in a smaller sample to investigate test-retest repeatability and interassessor reproducibility. The cpRNFL thickness was assessed in four quadrants, at several visual angles from the optic nerve center.
Results
Scanning was attempted in both eyes of 90 children with pediatric glaucoma and 180 controls to investigate feasibility (mean age, 6.98 ± 4.42 years). Scanning was not possible in 68 eyes of glaucoma children mainly owing to nystagmus, unclear optical media, or high refractive errors. Where three-dimensional imaging was possible, success at obtaining full cpRNFL was 67% in children with glaucoma and 89% for controls. Seventeen children with pediatric glaucoma and 34 controls contributed to reliability analysis (mean age, 6.3 ± 3.63 years). For repeatability intraclass correlation coefficients across quadrants ranged from 0.63 to 0.82 at 4° and improved to 0.88 to 0.94 at 6°. Intraclass correlation coefficients for reproducibility were also highest at 6° (>0.97 across all quadrants).
Conclusions
We demonstrate that acquisition and measurement of cpRNFL thickness values using 3-dimensional hand-held optical coherence tomography volumes in awake children is both feasible and reliable and is optimal at 6° from optic nerve center.
Translational relevance: Our recommended protocol provides guidance on how pediatric optic nerve pathologies are managed by clinicians.
MeSH Terms
Shields Classification
Key Concepts5
The success rate for obtaining full circumpapillary retinal nerve fiber layer (cpRNFL) using 3-dimensional hand-held optical coherence tomography was 67% in children with glaucoma and 89% in controls where imaging was possible, in a cohort of 90 children with pediatric glaucoma and 180 controls (mean age, 6.98 ± 4.42 years).
For repeatability of circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements using 3-dimensional hand-held optical coherence tomography, intraclass correlation coefficients (ICCs) across quadrants ranged from 0.63 to 0.82 at 4° from the optic nerve center and improved to 0.88 to 0.94 at 6° in a sample of 17 children with pediatric glaucoma and 34 controls (mean age, 6.3 ± 3.63 years).
Intraclass correlation coefficients (ICCs) for reproducibility of circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements using 3-dimensional hand-held optical coherence tomography were highest at 6° from the optic nerve center (>0.97 across all quadrants) in a sample of 17 children with pediatric glaucoma and 34 controls (mean age, 6.3 ± 3.63 years).
Acquisition and measurement of circumpapillary retinal nerve fiber layer (cpRNFL) thickness values using 3-dimensional hand-held optical coherence tomography volumes in awake children is both feasible and reliable, and is optimal at 6° from the optic nerve center.
Scanning for 3-dimensional full circumpapillary retinal nerve fiber layer (cpRNFL) imaging using hand-held optical coherence tomography was not possible in 68 eyes of children with glaucoma, primarily due to nystagmus, unclear optical media, or high refractive errors, in a cohort of 90 children with pediatric glaucoma and 180 controls (mean age, 6.98 ± 4.42 years).
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