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Optic Nerve Head Development in Healthy Infants and Children Using Handheld Spectral-Domain Optical Coherence Tomography

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Optic nerve head tomograms of the left retina from an infant 9 months of age. A, Diametric parameters: (a) disc diameter, from nasal to temporal Bruch's membrane (red); (b) cup depth, vertical distance from cup base to midpoint of neuroretinal peaks (grey); (c) cup diameter, measured at midpoint of cup depth (blue). B, Peripapillary parameters measured at 1700 μm and 6.0° from central disc diameter: (d) retinal nerve fiber layer (RNFL), thickness measurement of hyperreflective tissue inferior to inner limiting membrane (ILM; green); (e) retinal thickness, thickness measurement from ILM to Bruch's membrane (purple). C, Natural scale image with basement membrane opening minimum rim width measurement: (f) yellow.
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fig1: Optic nerve head tomograms of the left retina from an infant 9 months of age. A, Diametric parameters: (a) disc diameter, from nasal to temporal Bruch's membrane (red); (b) cup depth, vertical distance from cup base to midpoint of neuroretinal peaks (grey); (c) cup diameter, measured at midpoint of cup depth (blue). B, Peripapillary parameters measured at 1700 μm and 6.0° from central disc diameter: (d) retinal nerve fiber layer (RNFL), thickness measurement of hyperreflective tissue inferior to inner limiting membrane (ILM; green); (e) retinal thickness, thickness measurement from ILM to Bruch's membrane (purple). C, Natural scale image with basement membrane opening minimum rim width measurement: (f) yellow.

Mentions: Analysis was based primarily on a single B-scan through the deepest part of the optic cup to derive normative estimates for parameters that can be measured mainly in a clinical setting without the need for custom software (i.e., can be measured mainly using calipers). The B-scan image was randomized before analysis and was analyzed by 1 of 2 assessors (A.P. and R.P.) masked to the age of the participant to minimize bias. B-scan images were assessed and analyzed (Fig 1) using ImageJ software version 1.48 (available at: http://imagej.nih.gov/ij/ and provided in the public domain by the National Institutes of Health, Bethesda, MD).


Optic Nerve Head Development in Healthy Infants and Children Using Handheld Spectral-Domain Optical Coherence Tomography
Optic nerve head tomograms of the left retina from an infant 9 months of age. A, Diametric parameters: (a) disc diameter, from nasal to temporal Bruch's membrane (red); (b) cup depth, vertical distance from cup base to midpoint of neuroretinal peaks (grey); (c) cup diameter, measured at midpoint of cup depth (blue). B, Peripapillary parameters measured at 1700 μm and 6.0° from central disc diameter: (d) retinal nerve fiber layer (RNFL), thickness measurement of hyperreflective tissue inferior to inner limiting membrane (ILM; green); (e) retinal thickness, thickness measurement from ILM to Bruch's membrane (purple). C, Natural scale image with basement membrane opening minimum rim width measurement: (f) yellow.
© Copyright Policy - CC BY
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036922&req=5

fig1: Optic nerve head tomograms of the left retina from an infant 9 months of age. A, Diametric parameters: (a) disc diameter, from nasal to temporal Bruch's membrane (red); (b) cup depth, vertical distance from cup base to midpoint of neuroretinal peaks (grey); (c) cup diameter, measured at midpoint of cup depth (blue). B, Peripapillary parameters measured at 1700 μm and 6.0° from central disc diameter: (d) retinal nerve fiber layer (RNFL), thickness measurement of hyperreflective tissue inferior to inner limiting membrane (ILM; green); (e) retinal thickness, thickness measurement from ILM to Bruch's membrane (purple). C, Natural scale image with basement membrane opening minimum rim width measurement: (f) yellow.
Mentions: Analysis was based primarily on a single B-scan through the deepest part of the optic cup to derive normative estimates for parameters that can be measured mainly in a clinical setting without the need for custom software (i.e., can be measured mainly using calipers). The B-scan image was randomized before analysis and was analyzed by 1 of 2 assessors (A.P. and R.P.) masked to the age of the participant to minimize bias. B-scan images were assessed and analyzed (Fig 1) using ImageJ software version 1.48 (available at: http://imagej.nih.gov/ij/ and provided in the public domain by the National Institutes of Health, Bethesda, MD).

View Article: PubMed Central - PubMed

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.

No MeSH data available.