Overhead Mounted Optical Coherence Tomography in Childhood Glaucoma Evaluation

Abstract

Précis: Overhead mounted spectral-domain optical coherence tomography (OCT) enables high-quality imaging of the optic nerve and macula in childhood glaucoma, and is particularly useful when standard tabletop OCT has failed or is not possible. Purpose: Tabletop OCT, integral to adult glaucoma management, can be limited in childhood glaucoma patients because of young age, poor cooperation, and/or technical challenges. To address these imaging difficulties, we determined the feasibility and quality of an overhead mounted unit in childhood glaucoma. Secondary aims included evaluation of peripapillary retinal nerve fiber layer (pRNFL), parafoveal total retinal thickness, and parafoveal ganglion cell complex (GCC) thickness. Materials and Methods: Children and adults with a diagnosis of childhood glaucoma were imaged with an overhead mounted spectral-domain OCT as part of a prospective cross-sectional study. Participants had poor quality or unobtainable tabletop OCT and were scheduled for an examination under anesthesia and/or surgery as part of standard care. Results: A total of 88 affected eyes in 60 of 65 (92.3%) enrolled patients (mean age, 5.9±5.9 y; range, 0.2 to 24.5) were successfully imaged. The mean image quality for analyzed scans was 22.9±6.0 dB (n=236 images). Mean values for pRNFL (80.5±31.0 µm; n=86), parafoveal total retinal thickness (301.10±39.9 µm; n=79), and parafoveal GCC thickness (96.0±21.6 µm; n=74) were calculated. Conclusions: Overhead mounted OCT allowed high-quality image acquisition and analysis in childhood glaucoma patients unable to be imaged with the tabletop counterpart, presenting an opportunity for improved clinical management and study of childhood glaucoma-related pathophysiology. pRNFL, parafoveal total retinal thickness, and parafoveal GCC thickness were decreased for affected eyes of children under 6 years of age compared with age-matched controls from a companion normative study.

Changes of Peripapillary Retinal Nerve Fiber Layer in Childhood Glaucoma: A Systematic Review and Meta-Analysis

“…Our focus should be especially on cup depth and morphology of lamina cribrosa testing RNFL thinning by SD-OCT in pediatric patients. Some of the included studies elucidated the stage of glaucoma (25,26) and others were not (27)(28)(29)(30)(31)(32)(33), which may influence our metaanalysis of RNFL thickness. These could explain the high degree of statistical heterogeneity between the studies in the metaanalysis.…”

“…The high-quality image can be acquired and analyzed by handheld and overhead-mounted OCT in very young patients. Updated SD-OCT has presented benefits for improved clinical management and study of the pathophysiology associated with childhood glaucoma ( 31 , 33 ).…”

“…Some researchers have reported the thinning of average pRNFL thickness in all sectors between pediatric glaucoma and controls (25)(26)(27)(28)(29)(30). However, other studies have found that children with glaucoma and normal participants have comparable pRNFL thickness in some regions such as the temporal, nasal, and inferior nasal quadrants (31)(32)(33)(34). Thus, the possible association of each sector between pRNFL thickness and childhood glaucoma remains unclear, which justifies the need for more studies on this issue.…”

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

“…Others have shown that OCT imaging of RNFL thickness in infants and young children enables earlier identification of damage from optic nerve glioma, with ongoing validation studies ( 94 – 96 ). OCT has also been utilized to assess optic nerve injury in infants with primary congenital glaucoma or glaucoma after infant cataract surgery ( 97 ), and the OCT imaging has revealed previously unrecognized injury to other retinal areas, presumed to be ischemic in nature. Handheld OCT imaging is also currently under evaluation for assessment of early vigabatrin effects on the retina in infants treated for infantile spasm.…”

Minimally invasive glaucoma surgery in childhood glaucoma

“…There are many challenges to childhood glaucoma management including disease heterogeneity, diagnostic limitations [1,3,4], and the long disease course for which multiple surgeries may be required over a patient's lifetime. The treatment is primarily surgical, but medications play an adjunctive role and may be particularly effective in certain types of glaucoma (e.g.…”