Optical coherence tomography in pediatric ophthalmology: Insights into ocular development, diagnosis and management of eye diseases.

Abstract

Optical coherence tomography (OCT) is a non-invasive imaging modality that has revolutionized pediatric ophthalmology. This overview summarizes current evidence on OCT use across the pediatric age spectrum, emphasizing its role in imaging ocular development and guiding the diagnosis and management of pediatric eye diseases. Handheld OCT enables imaging in neonates, infants and children of any age, including those with developmental delays or poor cooperation. The acquisition and interpretation of pediatric OCT images require specific protocols and adjustments for shorter axial length, steeper corneal curvature, higher refractive error, and a faster rate of axial growth. Regarding ocular development, OCT has allowed detailed characterization of retinal layer maturation, foveal pit formation, and optic nerve head changes from infancy through adolescence. These insights form the basis for distinguishing normal variation from early signs of pathology. In pediatric diseases, OCT delivers objective structural biomarkers for diagnosis, staging, and monitoring. In prematurity, it delineates retinopathy of prematurity and hypoxic-ischemic injury. It defines congenital optic disc anomalies and grades foveal hypoplasia especially in children with nystagmus, clarifying prognosis. In optic neuropathies - inherited, compressive, or traumatic - OCT quantifies axonal loss for longitudinal follow-up. In amblyopia, it reveals choroidal and retinal alterations. OCT guides care in glaucoma, retinal vascular disease, uveitis, inherited retinal dystrophies, and ocular infections by tracking retinal and optic nerve changes. OCT also informs evaluation of retinoblastoma, neurocutaneous and lysosomal storage disorders, nystagmus and abusive head trauma. Overall, OCT is now indispensable for advancing earlier intervention and improving long-term outcomes in pediatric ophthalmology. Across pediatric eye diseases, OCT provides structural information that facilitates early diagnosis, informs assessment of disease severity, guides management decisions, and enables longitudinal follow-up. It plays a critical role in prematurity-related pathology, congenital optic disc anomalies, foveal hypoplasia, optic neuropathies, glaucoma, retinal vascular and inflammatory disorders, inherited retinal dystrophies, ocular tumors, and neuro-ophthalmic conditions. Overall, OCT has become an essential tool for integrating structural insight into clinical decision-making in pediatric ophthalmology.

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