Quantitative and qualitative assessment of anterior segment optical coherence tomography capture of disease state in childhood anterior uveitis

Abstract

Background/aimsAnterior segment optical coherence tomography (AS-OCT) assessment of anterior chamber inflammation is an emerging tool. We describe the performance of AS-OCT in a paediatric population.MethodsA mixed-methods prospective study, using routine clinical assessment as reference standard, and AS-OCT, with Tomey CASIA2 or Heidelberg Spectralis HS1, as index test, with data collected on patient perceptions of imaging. Repeatability, diagnostic indices, responsiveness to clinical change and clinical correlations of imaging-based metrics (image cell count, size, density and brightness) were assessed, with construction of receiver operated characteristic curves. Exploratory thematic analysis of responses from families was undertaken.ResultsA total of 90 children (180 eyes) underwent imaging. Bland Altman limits of agreement for CASIA2 repeatability ranged from +17 cells (95% CI 13.6 to 21.1) to −19 cells (95% CI −15.6 to −23.2) and HS1 from +1 (95% CI 0.9 to 1.2) to −1.0 (−1.2 to −0.8) cells. CASIA2 imaging had higher sensitivity of 0.92 (95% CI 0.78 to 0.97) vs HS1 imaging 0.17 (95% CI 0.07 to 0.34), with positive correlation between clinical grade and CASIA2 cell count (coefficient 12.8, p=0.02, 95% CI 2.2 to 23.4). Change in clinical grade at follow-up examinations correlated with change in image based ‘cell’ count (r2=0.79, p<0.001). Patients reported a potential positive impact of seeing their disease activity.ConclusionOur findings suggest that OCT-based imaging holds the promise of deeper understanding of disease, improved patient experience and more granular monitoring of activity with resultant improved outcomes, but further work is needed to refine acquisition and analysis protocols.

Novel diagnostic indicators for acute angle closure secondary to lens subluxation based on anterior segment and lens parameters

“…It can be used to predict anterior chamber angle for phakic intraocular lens implantation with deeper, wider and faster scanning of anterior segment combined with sophisticated mathematical modeling, which could greatly reduce the risks associated with the narrowing of the anterior chamber angle postoperatively [ 21 ]. It could also be applied to assess the anterior chamber inflammation with higher resolution images [ 23 , 24 ]. Besides, it has been reported to predict IOL tilt and decentration in modern cataract surgery [ 25 ].…”

Automated Quantitative Analysis of Anterior Segment Inflammation Using Swept-Source Anterior Segment Optical Coherence Tomography: A Pilot Study

“…Thus far, varying OCT devices, including time-domain OCT, spectral domain OCT, and swept-source OCT, have been used for studies to assess the anterior chamber cells in uveitis [ 7 , 8 ]. Recent studies have demonstrated the feasibility of AS-OCT for the quantification of anterior chamber cells in children with uveitis [ 25 , 26 ]. The accurate assessment of anterior chamber inflammation needs prolonged time to observe the anterior segment of uveitic eyes; however, younger children may be uncooperative for slit-lamp microscope examination due to the bright illumination of the slit-lamp beam [ 25 , 26 ].…”

“…Recent studies have demonstrated the feasibility of AS-OCT for the quantification of anterior chamber cells in children with uveitis [ 25 , 26 ]. The accurate assessment of anterior chamber inflammation needs prolonged time to observe the anterior segment of uveitic eyes; however, younger children may be uncooperative for slit-lamp microscope examination due to the bright illumination of the slit-lamp beam [ 25 , 26 ]. SS-OCT used in this study has the advantage of high scanning speed, leading to a rapid scan time [ 15 , 16 , 27 ].…”

“…A previous study demonstrated the potential of AS-OCT to differentiate groups of inflammatory cells (polymorphonuclear pattern vs. mononuclear pattern) based on the reflectance distribution [ 13 ]. A recent study also has shown that the eyes of children with active juvenile idiopathic arthritis-associated uveitis and idiopathic panuveitis had a tendency towards populations of cells/particles with larger areas compared to the baseline of idiopathic chronic anterior uveitis [ 26 ]. Although our study did not evaluate the reflectance and size of each spot in each disease type, aqueous cell differentiation using AS-OCT may provide useful information for the diagnosis and approach to the treatment of uveitis.…”

An Overview of Pediatric Uveitis

“…Anterior segment OCT is a relatively new method to quantify cells in the anterior chamber and needs to be standardized for routine use. 31 …”