Normative reference ranges for the retinal nerve fiber layer, macula, and retinal layer thicknesses in children

The macula in pediatric glaucoma: quantifying the inner and outer layers via optical coherence tomography automatic segmentation

BACKGROUND

Recent Spectralis (Heidelberg, Germany) spectral domain optical coherence tomography (SD-OCT) research software can automatically quantify the thickness of each individual retinal layer. The macular ganglion cell layer (GCL) and ganglion cell complex may be more sensitive for detecting glaucoma than the peripapillary retinal nerve fiber layer (pRNFL). The aim of this study was to characterize and compare the volume of each macular layer in the eyes of children with glaucoma versus those of normal controls.

METHODS

The medical records of children with primary glaucoma and physiologic cupping who had undergone Spectralis SD-OCT imaging of the macula and pRNFL were reviewed retrospectively. Controls were recruited from a separate prospective study. Children with refractive error of <±5 or retinal or neurologic abnormalities were excluded. The average volume of each of the 8 retinal layers in the macula (central 6 mm) and pRNFL were compared among diagnostic groups.

RESULTS

A total of 80 eyes of 80 children were included: 37 glaucoma eyes (25 with primary congenital and 12 with juvenile open-angle glaucoma) and 43 nonglaucoma eyes (28 with physiologic cupping). Eyes with glaucoma had significantly thinner mean macular nerve fiber layers, ganglion cell layers, inner plexiform layers, and pRNFLs than nonglaucomatous eyes: 0.82 ± 0.24 μm versus 1.00 ± 0.12 μm; 0.93 ± 0.22 μm versus 1.13 ± 0.10 μm; 0.80 ± 0.14 μm versus 0.91 ± 0.07 μm; 81.6 ± 26.5 μm versus 102.7 ± 10.0 μm, respectively (P < 0.00556 for all). Eyes without cupping and those with physiologic cupping were equivalent for all variables tested.

CONCLUSIONS

Children with glaucoma have thinning of the three innermost retinal macular layers.

Relationship between Age and Retinal Nerve Fiber Layer Thickness in Normal Children

PURPOSE

To evaluate the effect of age and ocular factors on peripapillary retinal nerve fiber layer (RNFL) thickness in children.

METHOD

A total of 198 normal subjects aged <19 years received a comprehensive ophthalmologic examination, including measurement of visual acuity, axial length, and cycloplegic refraction. Fast optical coherence tomography RNFL scans were obtained and average RNFL thickness was adjusted for ocular magnification. One eye of each subject was randomly selected as the study eye. The correlations between age and other ocular variables were examined.

RESULTS

Mean subject age was 8.61 ± 3.12 years. Average RNFL thickness and ocular magnification-corrected average RNFL thickness were 107.71 ± 11.83 and 103.03 ± 12.53 μm, respectively. There was no significant correlation between observed RNFL thickness and spherical equivalent of the refractive error (SE), axial length, or age (all P >0.05). Corrected RNFL thickness was positively correlated with age and axial length and negatively correlated with SE (P <0.01). Age was negatively correlated with the percent difference between observed and corrected RNFL thickness (P <0.001). Multivariate linear regression analysis showed that both axial length and age were correlated with corrected RNFL thickness in subjects <15 years old (P <0.05).

CONCLUSION

The RNFL thickness is likely to be overestimated in children <15 years old. Additionally, an RNFL thickness increase was observed in children <15 years old. Thus, ocular magnification and RNFL thickness increase should be considered when assessing RNFL thickness in patients <15 years old.

Use of Ocular Coherence Tomography in Children With Idiopathic Intracranial Hypertension-A Single-Center Experience

BACKGROUND

Idiopathic intracranial hypertension is a disorder characterized by elevated intracranial pressure without an identifiable etiology. Detection of papilledema may be challenging and leads to diagnostic uncertainty in evaluating a child for possible idiopathic intracranial hypertension. Ocular coherence tomography has the potential to add accuracy to the diagnosis of idiopathic intracranial hypertension. The goal of the present study was to determine if there was a relationship between severity of papilledema (as determined by direct ophthalmoscopy and confirmed by fundus photography) and measures of ocular coherence tomography in a pediatric population with idiopathic intracranial hypertension.

METHODS

Thirteen pediatric patients were recruited prospectively after diagnosis of either definitive idiopathic intracranial hypertension (with papilledema) or possible idiopathic intracranial hypertension (without papilledema) at Children's Hospital of Michigan over a period of one year. Clinical data and results of initial ocular coherence tomography and visual field testing were collected and statistically analyzed.

RESULTS

The Frisén scale of papilledema significantly correlated with average retinal nerve fiber layer thickness of each eye (r = 0.633, P = 0.02 in right eye and r = 0.868, P = 0.001 in left eye). The retinal nerve fiber layer thickness (mean ± SD) was significantly higher in the definitive group than in the possible group (189 ± 65 μm vs 104 ± 10 μm in right eye, 165 ± 42 μm vs 106 ± 9 μm in left eye, P < 0.01 in both eyes).

CONCLUSIONS

Ocular coherence tomography may be used as a supplementary method to aid in the reliable detection of papilledema in evaluating a child for idiopathic intracranial hypertension.

Cobalamin C Deficiency Shows a Rapidly Progressing Maculopathy With Severe Photoreceptor and Ganglion Cell Loss

PURPOSE

To describe in detail the retinal structure and function of a group of patients with cobalamin C (cblC) disease.

METHODS

Patients (n = 11, age 4 months to 15 years) with cblC disease (9/11, early onset) diagnosed by newborn screening underwent complete ophthalmic examinations, fundus photography, near-infrared reflectance imaging, and spectral-domain optical coherence tomography (SD-OCT). Electroretinograms (ERGs) were performed in a subset of patients.

RESULTS

Patients carried homozygous or compound heterozygote mutations in the methylmalonic aciduria and homocystinuria type C (MMACHC) gene. Late-onset patients had a normal exam. All early-onset patients showed a maculopathy; older subjects had a retina-wide degeneration (n = 4; >7 years of age). In general, retinal changes were first observed before 1 year of age and progressed within months to a well-established maculopathy. Pseudocolobomas were documented in three patients. Measurable visual acuities ranged from 20/200 to 20/540. Nystagmus was present in 8/11 patients; 5/6 patients had normal ERGs; 1/6 had reduced rod-mediated responses. Spectral-domain OCT showed macular thinning, with severe ganglion cell layer (GCL) and outer nuclear layer (ONL) loss. Inner retinal thickening was observed in areas of total GCL/ONL loss. A normal lamination pattern in the peripapillary nasal retina was often seen despite severe central and/or retina-wide disease.

CONCLUSIONS

Patients with early-onset cblC and MMACHC mutations showed an early-onset, unusually fast-progressing maculopathy with severe central ONL and GCL loss. An abnormally thickened inner retina supports a remodeling response to both photoreceptor and ganglion cell degeneration and/or an interference with normal development in early-onset cblC.

Longitudinal and Cross-Sectional Analyses of Age Effects on Retinal Nerve Fiber Layer and Ganglion Cell Complex Thickness by Fourier-Domain OCT

Purpose

We studied the effects of age and intraocular pressure (IOP) on retinal nerve fiber layer (NFL) and macular ganglion cell complex (GCC) thickness in normal eyes.

Methods

Data from subjects from the multicenter Advanced Imaging for Glaucoma Study (AIGS) were analyzed. The data included yearly visits from the normal subjects in the AIGS study. Fourier-domain optical coherence tomography (FD-OCT) was used to measure retinal NFL and macular GCC on each visit. Mixed effect models were used to evaluate the longitudinal effect of age and IOP on the NFL and GCC thickness. The measurements at baseline were used to examine the cross-sectional effects.

Results

The analysis included 192 eyes (92 participants) from AIGS between 2009 and 2013. The longitudinal analyses showed overall GCC thickness decreased 0.25 ± 0.05 μm per year (P < 0.001) while the overall NFL thickness decreased 0.14 ± 0.07 μm per year (P = 0.04). The cross-sectional analyses showed the GCC thickness was 0.17 ± 0.05 μm thinner per year of baseline age (P < 0.001), while the NFL was 0.21 ± 0.06 μm thinner (P < 0.001). There was no significant IOP effect on either GCC or NFL from either the longitudinal or cross-sectional analysis.

Conclusions

Longitudinal and cross-sectional analyses provided consistent rates of approximately 0.2% per year of age-related thinning in NFL and GCC thicknesses. This is relevant in establishing criteria to detect glaucoma-related thinning (disease progression) in excess of normal aging. IOP does not seem to be a significant confounder for progression analysis.

Translational Relevance

This study demonstrated the relevance of advanced imaging technology in diagnosing and monitoring glaucoma disease.

Macular Thickness in Myopia: An OCT Study of Young Chinese Patients

PURPOSES

To investigate macular thickness (MT) in young myopic Chinese patients using Spectralis optical coherence tomography (OCT) and to assess its association with gender, axial length (AL), spherical equivalent (SE), and intraocular pressure (IOP).

METHODS

Included in this study were 133 myopic Chinese patients, aged 18-30 years. All underwent complete ophthalmic examinations and Spectralis OCT. Inner, central, and outer foveal regions of the macula were measured.

RESULTS

The central fovea was the thinnest of the three macular regions (mean thickness, 250.1 ± 15.3 μm). Women had consistently thinner MTs than did men, except in the outer superior and inferior areas. Central foveal thickness (CFT) was positively correlated with AL and negatively correlated with SE. In the inner and outer regions, MT was positively correlated with SE. AL was negatively correlated with MT in all quadrants of the inner and outer sectors, but not the inner superior and outer nasal areas. No macular measurement was significantly correlated with age or IOP in either gender.

CONCLUSIONS

Variables affecting MT should be considered when evaluating SD-OCT data in young myopic Chinese patients, with and without retinal diseases.

DIRECTIONAL OPTICAL COHERENCE TOMOGRAPHY PROVIDES ACCURATE OUTER NUCLEAR LAYER AND HENLE FIBER LAYER MEASUREMENTS

PURPOSE

The outer nuclear layer (ONL) contains photoreceptor nuclei, and its thickness is an important biomarker for retinal degenerations. Accurate ONL thickness measurements are obscured in standard optical coherence tomography (OCT) images because of Henle fiber layer (HFL). Improved differentiation of the ONL and HFL boundary is made possible by using directional OCT, a method that purposefully varies the pupil entrance position of the OCT beam.

METHODS

Fifty-seven normal eyes were imaged using multiple pupil entry positions with a commercial spectral domain OCT system. Cross-sectional image sets were registered to each other and segmented at the top of HFL, the border of HFL and the ONL and at the external limiting membrane. Thicknesses of the ONL and HFL were measured and analyzed.

RESULTS

The true ONL and HFL thicknesses varied substantially by eccentricity and between individuals. The true macular ONL thickness comprised an average of 54.6% of measurements that also included HFL. The ONL and HFL thicknesses at specific retinal eccentricities were poorly correlated.

CONCLUSION

Accurate ONL and HFL thickness measurements are made possible by the optical contrast of directional OCT. Distinguishing these individual layers can improve clinical trial endpoints and assessment of disease progression.

Normative Spectral Domain Optical Coherence Tomography Data in Healthy Turkish Children

PURPOSE

To determine the normative database of macular and retinal nerve fiber layer (RNFL) thickness parameters in healthy Turkish children by OCT.

METHODS

318 eyes of 318 children (138 boys, 183 girls) aged between 3 and 17 years were evaluated. The children were scanned by Cirrus HD-OCT (Carl Zeiss Meditec) to measure the macula, RNFL, and optic nerve head parameters.

RESULTS

Axial length (AL) (p < 0.001, R²= 0.08), spherical equivalent (SE) (p < 0.001, R²= 0.12), and rim area (p < 0.001, R²= 0.15) were the strongest predictors of RNFL thickness. All of the macular measurements were significantly related to age (p < 0.001, R²> 5%). Average macular thickness (p < 0.01) and outer macula (p = 0.002) showed significant relationship with the AL and SE.

CONCLUSION

This study ensures an age-adjusted pediatric normative database using OCT to diagnose and monitor macular diseases, optic nerve diseases, and glaucoma in children.

Optic nerve morphology in normal children

PURPOSE

To expand the normative database of pediatric eyes analyzed with the Optovue optical coherence tomography (OCT).

METHODS

In a community-based, cross-sectional analysis, 77 healthy 5-year-old children were recruited from pediatric practices. No subject had any known ocular disorder. Their optic nerves were assessed using Optovue optical coherence tomography (OCT). Data were compared to the normative database obtained by Optovue for adults, ages 18-25, 40-45, and 55-60. Comparisons included thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), and optic nerve head disk area, vertical (VCD) and horizontal (HCD) cup:disk ratios, and cup area.

RESULTS

In comparison to all adult age groups, the children's optic nerve heads were statistically less cupped (cup area, VCD, HCD), all with P values of <0.0003. No statistical difference was identified between the children and adults aged 18-25 and 40-45 with respect to RNFL or GCC. Both RNFL and GCC were thicker in the children compared to adults aged 55-60 (P < 0.003). Children's disk area's were marginally smaller than those of adults, the difference not reaching statistical significance.

CONCLUSIONS

Our OCT results demonstrate that young children's optic nerves are statistically less cupped than those of all normal adults. The children's RNFL and GCC are statistically thicker than those of adults aged 55-60.

Macular retinal layer thickness in childhood

PURPOSE

To examine macular retinal thickness and retinal layer thickness with spectral domain optical coherence tomography in a population of children with normal ocular health and minimal refractive errors.

METHODS

High-resolution macular optical coherence tomography scans from 196 children aged 4 years to 12 years (mean age: 8 ± 2 years), were analyzed to determine total retinal thickness and thickness of 6 different retinal layers across the central 5 mm of the posterior pole. Automated segmentation with manual correction was used to derive retinal thickness values.

RESULTS

The mean total retinal thickness in the central 1-mm foveal zone was 255 ± 16 μm, and this increased significantly with age (mean increase of 1.8 μm per year) in childhood (P < 0.001). Age-related increases in thickness of some retinal layers were also observed, with changes of the highest statistical significance found in the outer retinal layers in the central foveal region (P < 0.01). Significant topographical variations in thickness of each of the retinal layers were also observed (P < 0.001).

CONCLUSION

Small magnitude, statistically significant increases in total retinal thickness and retinal layer thickness occur from early childhood to adolescence. The most prominent changes seem to occur in the outer retinal layers of the central fovea.

Macular Thickness Assessed with Optical Coherence Tomography in Young Chinese Myopic Patients

Purpose. To evaluate the variations in macular thickness in young Chinese myopic persons and the association with axial length (AL), spherical equivalence refraction (SE), age, intraocular pressure, and sex. Methods. In total, 133 young Chinese myopic subjects between 18 and 30 years of age were selected. The macular thickness was assessed using third-generation optical coherence tomography. AL, intraocular pressure, and SE were also measured. Results. The mean central foveal thickness was 191.1 ± 15.3 µm. The macula was consistently thinner in women than in men. Central foveal thickness had a significant positive correlation with AL and a negative correlation with SE. In the inner and outer regions, the macular thickness had a positive correlation with SE and negative correlation with AL. Conclusions. The retina was thinner in women than in men. Associated with myopic progression and AL extension, the central foveal thickness increased, while the retinal thickness of the inner and outer regions decreased.

Study of Spectral-Domain Optical Coherence Tomography in Children: Normal Values and Influence of Age, Sex, and Refractive Status

Purpose

To establish normal values for retinal nerve fiber layer (RNFL), macular thickness, and macular volume in children using spectral-domain optical coherence tomography (OCT).

Methods

A descriptive cross-sectional study was performed in healthy children between 3 and 14 years of age. Each child underwent a comprehensive ophthalmic examination that included 3 OCT scans with Spectralis (Heidelberg Engineering, Heidelberg, Germany). All measurements were performed by the same operator, and one eye was randomly selected. The influence of age, sex, and refraction on OCT measurements was analyzed.

Results

The sample consisted of 162 Caucasian subjects, mean age 8.1 ± 3.03 years. The spherical equivalent was 0.03 ± 0.19 D (range ±4 D, astigmatism <1 D). The average values were 263.69 ± 4.54 µm for central macular thickness, 0.21 ± 0.01 mm3 for central macular volume, and 100.45 ± 1.98 µm for RNFL. A significant correlation between RNFL and spherical equivalent was found for the nasal (p = 0.001), inferior (p = 0.009), and inferior nasal (p = 0.005) sectors. No differences were found with regard to sex (p>0.05). However, central macular thickness and central macular volume were correlated with age (p = 0.027, p = 0.02).

Conclusions

This study provides reference values for macular thickness, macular volume, and RNFL in healthy children.

Evaluation of the retinal ganglion cell layer thickness in healthy Turkish children

PURPOSE

To identify the distribution, variation, and determinants of ganglion cell-inner plexiform layer (GC-IPL) thickness in healthy Turkish children measured by high-definition optical coherence tomography (HD-OCT).

PATIENTS AND METHODS

This institutional study involved 296 eyes from 296 healthy children aged between 3 and 17 years. Each child underwent a dilated eye examination, cycloplegic refraction, and axial length measurement using Nidek AL-Scan optical biometer. Macular scan was used to measure the GC-IPL thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness was measured using the HD-OCT (Cirrus HD-OCT). Right eye of each subject was selected for analysis.

RESULTS

A total of 296 children (125 boys, 171 girls) were included in this study. The mean age of the children was 9.62±4.10 years (range, 3 to 17 y). The mean spherical equivalent was -0.09±1.49 D. The mean AL was 23.03±1.03 mm. The mean overall GC-IPL thickness was 83.44±5.52 μm and RNFL thickness was 96.91±10.21 μm. They were thicker than has been reported in adults. According to age-adjusted multiple regression analyses significant predictors of mean GC-IPL thickness were peripapillary RNFL thickness and AL (P<0.001).

CONCLUSIONS

This study ensures a pediatric normative database of GC-IPL using spectral-domain OCT. This information may provide to diagnosis and monitoring of optic nerve diseases and glaucoma in children.

Macular thickness assessed with spectral domain OCT in a population-based study of children: normative data, repeatability and reproducibility and comparison with time domain OCT

PURPOSE

To collect data on macular thickness assessed with Cirrus OCT in healthy children in a population-based study, to examine the repeatability and reproducibility, and to compare the values with Stratus OCT.

METHODS

Fifty-eight 6- to 15-year-old children, born at term, were examined. Best-corrected visual acuity and refraction were assessed. One examiner performed three OCT assessments, and the repeatability was calculated. Thereafter, a second examiner repeated the examinations to calculate the reproducibility. One eye was randomized to be included in the normal material. Finally, the second examiner assessed the macular thickness with the Stratus OCT.

RESULTS

The mean value (±SD) of central macular thickness was 255 ± 17 μm, and the total macular volume was 10.3 ± 0.5 mm(3) . No correlations were found between macular thickness and age, gender or refraction. The coefficients of variance (CoVs) for both repeatability and reproducibility were <1.21%, and the intraclass correlations (ICCs) were over 0.86. The Cirrus OCT showed a 29% thicker central macular thickness than the Stratus OCT.

CONCLUSION

Normal values for macular thickness assessed with Cirrus OCT in healthy full-term children in a population-based study were reported. The assessments showed high repeatability and reproducibility. The values of Cirrus and Stratus OCT differed and the techniques were not interchangeable.

Thickness alterations of retinal nerve fiber layer in children with sleep-disordered breathing due to adenotonsillar hypertrophy

OBJECTIVE

This study is designed to assess whether hypoxia which is caused by apnea and hypopnea episodes, has an effect on retinal nerve fiber layer (RNFL) thickness, using optical coherence tomography (OCT) in pediatric patients with Adenotonsillar hypertrophy (ATH).

METHODS

Fifty-seven children patient with AHT, and 31 healthy non-AHT children (between 6 and 12 ages) were enrolled in this study. Obstructive symptoms of the patients with ATH were assessed by using OSA-18 survey. The patients were divided into 2 groups as mild (>60 and <80) and severe (>80) OSAS patients, according to OSA-18 survey total scores. RNFL thickness, in the four quadrants (superior, nasal, inferior and temporal) patient's both eyes, was measured by optical coherence tomography. RNFL parameters of control and patient groups were compared. Correlation between OSA survey scores and RNFL thickness of the patient groups were examined.

RESULTS

A positive correlation was found between ages and RNLF thickness of all subjects enrolled in this study (r=+0.107, p<0.05). And also a poor correlation was found between OSA-18 survey scores and RNFL parameters in patient group (between -0.031 and +0.016 at right and left eyes, p>0.05). No statistically significant alteration in RNFL thickness was found between the patient and control groups (p>0.05).

CONCLUSION

Age range (6-12) of the patients with ATH in our study considers that possible OSAS time was not long enough to affect RNLF thickness. Remembering the risk of optic injury development in children with ATH (in a long term), tonsillectomy and/or adenoidectomy operations shouldn't be delayed.

Applications of optical coherence tomography in pediatric clinical neuroscience

For nearly two centuries, the ophthalmoscope has permitted examination of the retina and optic nerve-the only axons directly visualized by the physician. The retinal ganglion cells project their axons, which travel along the innermost retina to form the optic nerve, marking the beginning of the anterior visual pathway. Both the structure and function of the visual pathway are essential components of the neurologic examination as it can be involved in numerous acquired, congenital and genetic central nervous system conditions. The development of optical coherence tomography now permits the pediatric neuroscientist to visualize and quantify the optic nerve and retinal layers with unprecedented resolution. As optical coherence tomography becomes more accessible and integrated into research and clinical care, the pediatric neuroscientist may have the opportunity to utilize and/or interpret results from this device. This review describes the basic technical features of optical coherence tomography and highlights its potential clinical and research applications in pediatric clinical neuroscience including optic nerve swelling, optic neuritis, tumors of the visual pathway, vigabatrin toxicity, nystagmus, and neurodegenerative conditions.

Assessment of retinal nerve fiber layer thickness in healthy, full-term neonates

PURPOSE

To measure average retinal nerve fiber layer (RNFL) thicknesses in healthy, full-term neonates.

DESIGN

Descriptive research to develop normative data.

METHODS

Healthy infants born between 37 and 42 weeks postmenstrual age were imaged with hand-held spectral-domain optical coherence tomography. A custom script segmented the RNFL; the fovea and optic nerve center were manually selected. A second script measured the average RNFL thickness along the papillomacular bundle, defined as the arc from -15 degrees to +15 degrees on the axis from the optic nerve to fovea, with radii of 1.1, 1.3, 1.5, and 1.7 mm from the center of the optic disc. Shapiro-Wilk W tests assessed these measurements for normality to determine the age-appropriate radial distance for subsequent analyses. Average RNFL thicknesses for four temporal 45-degree sectors (superior temporal, temporal superior, temporal inferior, and inferior temporal) and the temporal quadrant were calculated and compared to demographic parameters for all infants.

RESULTS

Fifty full-term infants were adequately imaged for RNFL analysis. RNFL thicknesses at 1.5 mm radial distance from the optic nerve were the most normally distributed. While there was a trend toward greater mean superior temporal RNFL thickness for both black and Hispanic vs white infants (128 ± 27 μm, 124 ± 30 μm, and 100 ± 19 μm, respectively, P = .04 for both comparisons), there were no other significant differences noted in RNFL thicknesses by race, sex, gestational age, or birth weight.

CONCLUSIONS

We present RNFL thickness measurements for healthy, full-term infants that may serve as normative data for future analyses.

Inflammatory Papillitis in Uveitis: Response to Treatment and Use of Optic Nerve Optical Coherence Tomography for Monitoring

PURPOSE

To describe the clinical course of uveitis-associated inflammatory papillitis and evaluate the utility and reproducibility of optic nerve spectral domain optical coherence tomography (SD-OCT).

METHODS

Data on 22 eyes of 14 patients with uveitis-related papillitis and optic nerve imaging were reviewed. SD-OCT measure reproducibility was determined and parameters were compared in active vs. inactive uveitis.

RESULTS

Papillitis resolution lagged behind uveitis resolution in three patients. For SD-OCT measures, the intraclass correlation coefficients were 99.1-100% and 86.9-100% for intraobserver and interobserver reproducibility, respectively. All SD-OCT optic nerve measures except inferior and nasal peripapillary retinal thicknesses were significantly higher in active vs. inactive uveitis after correction for multiple hypotheses testing. Mean optic nerve central thickness decreased from 545.1 to 362.9 µm (p = 0.01).

CONCLUSIONS

Resolution of inflammatory papillitis can lag behind resolution of uveitis. SD-OCT assessment of papillitis is reproducible and correlates with presence vs. resolution of uveitis.

The role of magnetic resonance imaging in diagnosing optic nerve hypoplasia

PURPOSE

To establish objective lower limits of normal optic nerve (ON) size in children based on high-resolution orbital magnetic resonance imaging (MRI).

DESIGN

Case-control study of patients with ON hypoplasia vs normal controls.

METHODS

A neuroradiologist made 4 measurements of each ON at 2 locations (5 mm posterior to the optic disc and just posterior to the optic canal) in patients with ON hypoplasia and controls aged 0-17 years from an academic eye center and children's hospital. Primary analyses were performed using mixed linear models.

RESULTS

Measurements were made in 26 cases of clinically confirmed ON hypoplasia and 31 controls (median age: ON hypoplasia, 1 year; controls, 5.5 years). Nine of 26 cases (35%) and 19 of 31 controls (61%) underwent high-resolution T2-weighted imaging of the orbits. Mean ON diameter was 1.36 mm (95% CI: 1.19-1.54; P < .001) smaller for clinically hypoplastic ONs than for controls. Optic nerve diameter increased by 0.05 mm per year of age (95% CI: 0.03-0.07; P < .001). A lower bound to the 95% prediction interval for normal optic nerves was (2.24 mm + 0.052 × [age in years]) mm and excluded all but 1 case.

CONCLUSIONS

Age was independently associated with normal ON size by MRI and should be taken into consideration when evaluating ON hypoplasia, based on MRI criteria. We have provided a formula to assist clinicians in objectively determining if ON hypoplasia is present.

Using spectral-domain optical coherence tomography to detect optic neuropathy in patients with craniosynostosis

BACKGROUND

Detecting and monitoring optic neuropathy in patients with craniosynostosis is a clinical challenge due to limited cooperation, and subjective measures of visual function. The purpose of this study was to appraise the correlation of peripapillary retinal nerve fiber layer (RNFL) thickness measured by spectral-domain ocular coherence tomography (SD-OCT) with indication of optic neuropathy based on fundus examination.

METHODS

The medical records of all patients with craniosynostosis presenting for ophthalmic evaluation during 2013 were retrospectively reviewed. The following data were abstracted from the record: diagnosis, historical evidence of elevated intracranial pressure, current ophthalmic evaluation and visual field results, and current peripapillary RNFL thickness.

RESULTS

A total of 54 patients were included (mean age, 10.6 years [range, 2.4-33.8 years]). Thirteen (24%) had evidence of optic neuropathy based on current fundus examination. Of these, 10 (77%) demonstrated either peripapillary RNFL elevation and papilledema or depression with optic atrophy. Sensitivity for detecting optic atrophy was 88%; for papilledema, 60%; and for either form of optic neuropathy, 77%. Specificity was 94%, 90%, and 83%, respectively. Kappa agreement was substantial for optic atrophy (κ = 0.73) and moderate for papilledema (κ = 0.39) and for either form of optic neuropathy (κ = 0.54). Logistic regression indicated that peripapillary RNFL thickness was predictive of optic neuropathy (P < 0.001). Multivariable analysis demonstrated that RNFL thickness measurements were more sensitive at detecting optic neuropathy than visual field testing (likelihood ratio = 10.02; P = 0.002). Sensitivity and specificity of logMAR visual acuity in detecting optic neuropathy were 15% and 95%, respectively.

CONCLUSIONS

Peripapillary RNFL thickness measured by SD-OCT provides adjunctive evidence for identifying optic neuropathy in patients with craniosynostosis and appears more sensitive at detecting optic atrophy than papilledema.

Cupping reversal in pediatric glaucoma--evaluation of the retinal nerve fiber layer and visual field

PURPOSE

To identify optic nerve head (ONH) cupping reversal and associated optical coherence tomography (OCT) and Humphrey visual field changes in pediatric glaucoma.

DESIGN

Retrospective observational case series.

METHODS

Sequential surgical cases of juvenile open-angle glaucoma (OAG) or primary congenital glaucoma (PCG) with sustained postoperative intraocular pressure (IOP) reduction. Group 1 had preoperative and postoperative ONH photographs and OCT; Group 2 had preoperative clinical ONH assessment and postoperative imaging. Cupping evaluation was confirmed by masked glaucoma and neuro-ophthalmology specialists.

RESULTS

Of 80 cases, 9 eyes (9 children) met criteria for Group 1; 24 eyes (19 children) met criteria for Group 2. Group 1: Five of 9 eyes (56%) demonstrated cupping reversal, with preoperative vs postoperative mean IOP 34.2 ± 6.6 mm Hg vs 10.6 ± 4.1 mm Hg (P < .00001) and mean average retinal nerve fiber layer (RNFL) 71.0 ± 30 μm vs 62.8 ± 24 μm (P = .4), respectively. RNFL was stable in 4 of 5 eyes (all juvenile OAG), but thinned (Δ = -41 μm) in 1 eye with PCG. Humphrey visual fields (reliable in 2 of 3 eyes) showed no significant change. Group 2: Fourteen of 24 PCG eyes (58%) demonstrated cupping reversal, with preoperative vs postoperative mean IOP 36.1 ± 8.9 mm Hg vs 13.3 ± 2.1 mm Hg (P < .00001). Two eyes had thin RNFL postoperatively despite healthy-appearing ONH. Postoperative RNFL showed statistically significant linear correlation with preoperative (but not postoperative) cup-to-disc ratio. Limitations include small numbers, few reliable Humphrey visual fields, and absent preoperative imaging (Group 2).

CONCLUSION

Some eyes with IOP reduction and ONH cupping reversal show continued RNFL thinning postoperatively. The preoperative ONH cup-to-disc ratio predicted the postoperative RNFL better than the postoperative "reversed and smaller" cup-to-disc ratio. Cupping reversal in pediatric glaucoma may not predict improved ONH health and deserves further study.

Intra- and inter-visit reproducibility of ganglion cell-inner plexiform layer measurements using handheld optical coherence tomography in children with optic pathway gliomas

PURPOSE

To determine the intra- and inter-visit reproducibility of ganglion cell-inner plexiform layer thickness measures using handheld optical coherence tomography (OCT) in sedated children with optic pathway gliomas and/or neurofibromatosis type 1 (NF1).

DESIGN

Prospective longitudinal cohort study.

METHODS

Children with sporadic optic pathway gliomas and/or NF1 who had ≥2 volumes acquired over the macula using handheld OCT during sedation for clinically indicated magnetic resonance imaging were eligible for the intra-visit cohort. Children with repeat handheld OCT imaging within 6 months were eligible for the inter-visit cohort. Total retinal thickness and ganglion cell-inner plexiform layer thickness were measured using custom-designed automated segmentation software. Reproducibility was compared across average and anatomic quadrant by calculating the coefficient of variation (CV) and intraclass correlation coefficient (ICC).

RESULTS

Forty-two subjects (median age 5.4 years, range 0.8-12.7 years) contributed 45 eyes to the intra-visit cohort. Thirty-one subject eyes had normal vision and 14 had abnormal vision (decreased visual acuity and/or visual field). Average and quadrant ganglion cell-inner plexiform layer measures demonstrated CVs ≤4.5% with excellent ICCs (>0.935). The superior quadrant CV differed between subjects with (4.4%) and without (2.1%) vision loss (P < .05). Twenty-five subject eyes were eligible for the inter-visit cohort, demonstrating CVs from 1.6% to 5.2%. Inter-visit ICCs were excellent (0.955-0.995).

DISCUSSION

Handheld OCT imaging in sedated children with optic pathway gliomas produces highly reproducible measures of ganglion cell-inner plexiform layer thickness.

Macular structural characteristics in children with congenital and developmental cataracts

PURPOSE

To investigate macular structural characteristics in children with congenital or developmental cataracts.

METHODS

Children 5-16 years of age with a history of surgery for congenital or acquired cataract were enrolled. Eligible patients had visual acuity of 20/400 or better and ≥37 weeks gestational age at birth. Patients were divided into two groups: unilateral (n = 22) and bilateral (n = 19). Fourier domain optical coherence tomography (FD-OCT) was used to image the retinal structure. Retinal volume scans centered on the fovea were obtained. Using the instrument's segmentation software, central subfield thickness (CST) and the thickness of the inner and outer retinal layer regions were measured.

RESULTS

In the unilateral group, 1 child with persistent fetal vasculature had unidentifiable retinal structure and was excluded. Most unilateral eyes (20/21) had a CST within the normal range. However, the CST, superior, nasal, inferior, and temporal sectors were all significantly thicker in the cataractous eye compared to the noncataractous eye (all P < 0.01 [paired t test]). The interocular difference for CST was not associated with age at surgery or interocular difference for visual acuity. In the bilateral group, although 34 of 38 eyes were within the normal range, the average CST of this group was significantly thicker than the noncataractous eye in the unilateral group.

CONCLUSIONS

Following cataract extraction during infancy or childhood, most cataractous eyes had normal macular structure. Cataractous eyes of both unilaterally and bilaterally affected children have thicker CST values compared to the noncataractous eye.

Choroidal thickness measurement in children using optical coherence tomography

PURPOSE

To measure choroidal thickness (CT) in children of various ages by using spectral optical coherence tomography with enhanced depth imaging and to investigate the association between subfoveal CT and ocular axial length, age, gender, weight, and height in children.

METHODS

Healthy children were prospectively included between May and August 2012. Optical coherence tomography with the enhanced depth imaging system (Spectralis, Heidelberg, Germany) was used for choroidal imaging at nine defined points of the macula of both eyes. Axial length was measured using IOLMaster (Carl Zeiss Meditec, Dublin, CA). Height, weight, and refraction were recorded. Interobserver agreement in readings was also assessed by the Bland-Altman Method.

RESULTS

Three hundred and forty-eight eyes from 174 children aged 3.5 years to 14.9 years were imaged. The mean subfoveal CT in right eyes was 341.96 ± 74.7 µm. Choroidal thickness increased with age (r = 0.24, P = 0.017), height, and weight but not with gender (P > 0.05). It was also inversely correlated to the axial length (r = 0.24, P = 0.001). The nasal choroid appeared thinner than in the temporal area (analysis of variance, P < 0.0001).

CONCLUSION

In children, CT increases with age and is inversely correlated to axial length. There is a significant variation of CT between children of the same age.

Spectral domain optical coherence tomography in children: normative data and biometric correlations

Background

The aim was to report normative values of retinal nerve fiber layer (RNFL) and macular parameters in children using spectral domain optical coherence tomography (OCT) and to perform correlations with age, refractive error and axial length.

Methods

This was an observational cross-sectional study recruiting 113 healthy children aged 6 to 17 years with no ocular abnormality except refractive error. After a comprehensive eye examination and axial length measurement, RNFL and macular thickness measurements were performed using the Cirrus OCT machine. Main outcome measures were macular volume, macular thickness and RNFL thickness values as well as their correlations with age, refractive error and axial length. Right eyes of all subjects were selected for analysis.

Results

One hundred and eight children were included in the study, 65 females and 43 males. Mean age was 10.7+/−3.1 years, average spherical equivalent refraction (SE) was −0.02+/−1.77(−4.25 to +5.00) diopters and average axial length was 23.5+/−1.0 (21.5 to 25.8)mm. Mean RNFL thickness was 95.6+/−8.7 μm, average macular thickness was 279.6+/−12.5 μm, central macular thickness was 249.1+/−20.2 μm, and mean macular volume was 10.1+/−0.5 mm³. Central macular thickness values were significantly higher in males (p < 0.001). RNFL measurements did not correlate with age but did show a positive correlation with SE. All macular parameters were consistently positively correlated with age and most of them were positively correlated with SE. When controlling for axial length, only the macular inner circle thickness was positively correlated with age.

Conclusions

Using Cirrus OCT, normative RNFL and macular parameters in healthy children below 18 years of age were established; measurements varied by age and gender.

Correlation of optical coherence tomography parameters with clinical and radiological progression in patients with symptomatic optic pathway gliomas

PURPOSE

To study the optical coherence tomography (OCT) characteristics in children with optic pathway glioma (OPG) to determine if OCT changes occur alongside clinical/radiological changes at diagnosis and during the second-year follow-up.

METHODS

Twenty-three patients (38 eyes) diagnosed with symptomatic OPG in a single institution were enrolled in this longitudinal observational cohort study. Complete ophthalmologic evaluation, including determination of visual acuity, visual fields, retinal nerve fiber layer ,and posterior pole retinal thickness scanning with spectral-domain optical coherence tomography, and neuroimaging was performed at the time of diagnosis and 6 months and 1 and 2 years after presentation. Patients who experienced visual decline or radioagraphic tumor enlargement of the OPG were classified as progressors. OCT data were compared between progressors and nonprogressors.

RESULTS

The average age at diagnosis was 5.8 years. All patients were followed up for 24 months. Five patients (21%) (eight eyes) had clinical or radiological progression of their OPG during follow-up and were classified as progressors. Mean changes in average nerve fiber layer and posterior pole retinal thickness were significantly higher for progressors compared with nonprogressors (P < 0.001). The area under the receiver operator characteristic curves comparing average nerve fiber layer and posterior pole retinal thinning between the progressors and nonprogressors were 0.94 and 0.95 respectively.

CONCLUSIONS

Optical coherence tomography of average nerve fiber layer and posterior pole retinal thickness may be helpful in monitoring OPG.