Optic Nerve Head Development in Healthy Infants and Children Using Handheld Spectral-Domain Optical Coherence Tomography.
Patel Aarti, Purohit Ravi, Lee Helena, Sheth Viral, Maconachie Gail, Papageorgiou Eleni, McLean Rebecca J, Gottlob Irene, Proudlock Frank A
AI Summary
Handheld SD-OCT successfully imaged pediatric ONH development. Key finding: Disc/cup diameters increase with age, while peripapillary RNFL initially decreases then slowly increases, providing normative data for clinical use.
Abstract
Purpose
To determine feasibility of optic nerve head (ONH) imaging and to characterize ONH development in full-term infants without sedation using handheld spectral-domain optical coherence tomography (SD OCT).
Design
Prospective cross-sectional study.
Participants
Three hundred fifty-two children aged between 1 day and 13 years.
Methods
All participants were imaged using handheld SD OCT without sedation during a single scan session. The percentage of successful scans was calculated. Interexaminer reproducibility and differences between right and left eyes were assessed using intraclass correlation coefficients (ICCs). Images were analyzed using ImageJ software. The developmental trajectories over time for ONH parameters were calculated using fractional polynomial modelling.
Main outcome measures
Disc and cup diameter (expressed as distance in micrometers and visual angle in degrees), cup depth, Bruch's membrane opening-minimum rim width (BMO-MRW), retinal thickness, and retinal nerve fiber layer (RNFL; 1700 μm and 6° from the disc center).
Results
On average, 70% of participants were imaged successfully. Interexaminer reliability was excellent (ICC, >0.89) for diametric and retinal thickness parameters. Right and left eyes were similar for diametric measurements (ICC, >0.79), but more variable for nasal BMO-MRW, RNFL, and retinal thickness. The mean disc and cup diameter increase by 30% and 40%, respectively, between birth and 13 years of age when expressed as a distance measure, but remained constant (at 5°-5.5° and 2°, respectively) when expressed as a visual angle with reference to the eye nodal point. The peripapillary temporal RNFL demonstrated a marked initial decrease of nearly 35% between birth and approximately 18 months of age. This was followed by a slow increase up to 12 years of age when measured at 1700 μm from the disc center, although there was little change when measured at 6° from the disc center.
Conclusions
We demonstrated feasibility of handheld SD OCT imaging of the ONH in full-term infants and children without anaesthesia or sedation. This is the first in vivo handheld SD OCT study to describe the development of ONH parameters during the critical early years of visual maturation. Our results provide a normative database for use in routine practice and further studies of ONH pathologic features.
MeSH Terms
Shields Classification
Key Concepts4
The mean disc and cup diameter in full-term infants and children increase by 30% and 40%, respectively, between birth and 13 years of age when expressed as a distance measure, but remained constant (at 5°-5.5° and 2°, respectively) when expressed as a visual angle with reference to the eye nodal point, as characterized using handheld spectral-domain optical coherence tomography (SD OCT).
The peripapillary temporal retinal nerve fiber layer (RNFL) in full-term infants and children demonstrated a marked initial decrease of nearly 35% between birth and approximately 18 months of age, followed by a slow increase up to 12 years of age when measured at 1700 μm from the disc center, though little change was observed when measured at 6° from the disc center, as characterized using handheld spectral-domain optical coherence tomography (SD OCT).
Handheld spectral-domain optical coherence tomography (SD OCT) imaging of the optic nerve head (ONH) in full-term infants and children without anaesthesia or sedation is feasible, with an average of 70% of participants imaged successfully.
Interexaminer reliability for diametric and retinal thickness parameters using handheld spectral-domain optical coherence tomography (SD OCT) was excellent (ICC, >0.89) in a study of 352 children aged between 1 day and 13 years.
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