Optical coherence tomography of the preterm eye: from retinopathy of prematurity to brain development

Abstract

Preterm infants with retinopathy of prematurity are at increased risk of poor neurodevelopmental outcomes. Because the neurosensory retina is an extension of the central nervous system, anatomic abnormalities in the anterior visual pathway often relate to system and central nervous system health. We describe optical coherence tomography as a powerful imaging modality that has recently been adapted to the infant population and provides noninvasive, high-resolution, cross-sectional imaging of the infant eye at the bedside. Optical coherence tomography has increased understanding of normal eye development and has identified several potential biomarkers of brain abnormalities and poorer neurodevelopment.

Simultaneous Fluorescein Angiography and Spectral Domain Optical Coherence Tomography Correlate Retinal Thickness Changes to Vascular Abnormalities in an In Vivo Mouse Model of Retinopathy of Prematurity

“…Approximately 6–18% of childhood blindness cases in developed countries can be attributed to ROP [1]. In the United States alone, 14,000–16,000 preterm infants are diagnosed with ROP every year, and the worldwide prevalence is increasing [2]. ROP prevalence has been shown to be strongly correlated to prematurity, low birth weight, and oxygen therapy [3, 4].…”

“…OCT has been gaining increasing use as a research and clinical diagnostic tool to provide a cross-sectional view of the retina and corresponding vasculature [2], thereby enhancing the study of ocular vascular diseases such as choroidal neovascularization [15] and retinal degeneration [16, 17]. Spectral domain optical coherence tomography (SD-OCT) has improved axial resolution over OCT and can provide further insight into intraretinal abnormalities [18].…”

Preterm infant retinal OCT markers of perinatal health and retinopathy of prematurity

“…Hence, OCT imaging of the RNFL presents a unique opportunity to non-invasively evaluate the central nervous system, and OCT-based RNFL thickness has been a non-invasive biomarker for axonal injury, independent of myelination changes and repeatedly accessible at the bedside ( Figure 6 ) ( 40 , 82 ). In preterm and term infants, we have demonstrated and validated the utility and reproducibility of measuring RNFL thickness at a radial distance of 1.5 mm from the center of the optic nerve in the sector between the optic nerve and macula ( 20 , 35 , 40 ).…”

“…We also found a significant correlation between thinner RNFL and worse cognitive and motor skills as assessed by the Bayley Scales ( 20 ). This study highlighted that RNFL thickness may be a promising non-invasive, bedside biomarker of brain injury and subsequent neurodevelopmental outcome as an adjunct tool to clinical MRI and is currently being evaluated in the larger BabySTEPS trial ( 20 , 82 ).…”

“…Research thus far demonstrates that birth weight, systemic inflammation such as sepsis/NEC and brain injury have an impact on the RNFL thickness. With the high incidence of poor neurodevelopmental outcomes in extremely preterm infants ( 83 ), RNFL could serve as a potential early, repeatable non-invasive biomarker for neurodevelopment ( 82 ). Longitudinal, prospective studies are needed to validate these findings and identify the role of RNFL thickness in clinical care.…”