Evaluation of the Nerve Fiber Layer and Macula in the Eyes of Healthy Children Using Spectral-Domain Optical Coherence Tomography

doi:10.1016/j.ajo.2011.08.026

American Journal of Ophthalmology

Volume 153, Issue 3, March 2012, Pages 552-559.e1

https://doi.org/10.1016/j.ajo.2011.08.026 Get rights and content

Purpose

To determine the normative values of the peripapillary retinal nerve fiber layer (RNFL), macular thickness, and macular volume in healthy children using spectral-domain optical coherence tomography (SD-OCT) and analyze the correlation of such values with age, refraction error, and biometric measurements.

Design

Observational case series.

Methods

This institutional study involved 107 eyes from 107 healthy pediatric patients (54 female, 53 male) with ages between 6 and 16 years. After the biometric measurements and refractive error values (in spherical equivalent) of the cases were obtained, the peripapillary RNFL, macular thickness, and macular volume values were calculated using the Spectralis OCT device.

Results

Among the study group, with an average age of 10.46 ± 2.94 years, the average axial length (AL) was 23.33 ± 0.89 mm; the average spherical equivalent (SE) value was −0.27 ± 0.99 diopter. The average peripapillary RNFL thickness was 106.45 ± 9.41 μm; the average macular thickness was 326.44 ± 14.17 μm; and the average macular volume was 0.257 ± 0.011 mm³. The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all).

Conclusions

This study reports SD-OCT findings among healthy pediatric cases. SD-OCT can be reliably used for pediatric patients because of its short exposure time and high degree of image resolution.

Section snippets

Methods

This study, consisting of a case series of healthy pediatric patients, was performed at the Gulhane Military Medical Faculty, Department of Ophthalmology, Ankara, Turkey, from June 25, 2010 to December 24, 2010.

The study involved pediatric patients with ages between 6 and 16 years, who applied to the ophthalmology polyclinic for a refractive error examination. Detailed demographic data related to the patients were obtained from the parents. Then, each participant was subjected to an

Study Group

The examination findings for 132 children among a total of 162 white children examined during the study met the study criteria. Twenty-four of those 132 patients were excluded because of failure to obtain parental consent, and 1 patient was excluded because the patient did not cooperate with SD-OCT measurements. The average age of all 107 children involved in the study (54 [50.47%] female and 53 [49.53%] male children) was 10.46 ± 2.94 years (range, 6-16). The median age of the group was 10

Discussion

Glaucoma is one of the most important causes of blindness throughout the world and a type of optic neuropathy that leads to retinal ganglion cell loss.²⁶ This disease induces a decrease in RNFL thickness, causing irreversible perimetric loss.¹⁸ The diagnosis and follow-up of glaucoma are problematic, especially in children.²⁷ The most important point in the disease is that the diagnosis should be established as early as possible before the perimetric findings arise, and permanent visual loss

Adem Turk, MD, is an Assistant Professor in the Department of Ophthalmology at the Karadeniz Technical University, Trabzon, Turkey. He received his medical degree from Karadeniz Technical University in 2001. He completed his general ophthalmology residency at the same university in 2006. His current research interests include retinal vascular diseases and glaucoma.

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Handheld optical coherence tomography (HH-OCT) lacks integrated segmentation/analysis software. Optic neuropathies cause ganglion cell layer (GCL) thinning, with normal to thickened inner nuclear layer (INL), suggesting the potential value of estimating the GCL/INL ratio on single-line foveal HH-OCT scans. This study determines this ratio in macular scans from healthy eyes of young children using HH-OCT and overhead-mounted OCT.
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HH-OCT was obtained on 38 eyes (38 children, mean age 2.4 ± 1.8 years) and FLEX-OCT on 56 eyes (56 children, mean age 2.3 ± 1.5 years). Mean nasal GCL/INL was 1.24 ± 0.18 (min/max = 0.92/1.75) for HH-OCT and 1.29 ± 0.18 (min/max = 0.96/1.66) for FLEX-OCT (P = 0.11). Mean temporal GCL/INL was 1.22 ± 0.24 (min/max = 0.66/1.70) for HH-OCT and 1.19 ± 0.16 (min/max = 0.86/1.47) for FLEX-OCT (P = 0.47).
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Premature children birth and survival is becoming more frequent due to the improvement in obstetric and neonatal care. This makes it increasingly common to find patients with history of preterm birth in ophthalmology clinics, both in pediatric and adult ages. Premature birth can lead to ocular structural changes, being possible to affect the ganglion cell complex (GCC), among other structures, which can be studied using optical coherence tomography.
To carry out a bibliographic review of the studies that analyze GCC in patients with a history of prematurity compared with patients born at term.
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Citation Excerpt :
Our study found weak to moderately significant correlation coefficients for standard RNFL thicknesses with RE, as well as categorical groupings according to RE. The relationship between the degree of myopia in children and standard RNFL thickness is open to debate; some studies have reported a correlation, while others have reported no correlation.[18–22] Although there is no histological study in the literature showing that ganglion cells and their axons decrease as a way to explain the thinning of the RNFL in myopia, Leung et al.[7] explain that mechanical stretching and thinning of the retina caused by elongation of the globe causes this.
It is debatable whether the decrease of retinal nerve fiber layer (RNFL) thickness in myopic people under 18 years of age is due to insufficient measurement techniques or to real physical loss of retinal ganglion cells and axons. Hence, to better understand the relationship between the degree of myopia and the neuroretinal rim (NR), we aim to investigate the NR in the eyes of healthy myopic children using the novel measurement algorithms of spectral-domain optical coherence tomography (SD-OCT).
This prospective, cross-sectional study includes 378 left eyes of 378 (301 female) participants divided into three groups according to their spherical equivalent (SE) refractive error (RE) [Group-1(G1), -1.00 ≤ SE ≤ 1.00 diopters (D); Group-2 (G2), -4.00 ≤ SE < -1.00 D; Group-3 (G3), SE<-4.00 D]. All participants underwent a full ophthalmic examination, including biometric and pachymetric measurements. Standard peripapillary RNFL, as well as the novel algorithms, Bruch's membrane opening-minimum rim width (BMO-MRW), and RNFL acquired using the anatomic positioning system (APS-RNFL) were obtained by SD-OCT. Nasal, temporal, temporal-inferior, temporal-superior, nasal-inferior, nasal-superior sectors’ and their general (global) averages were recorded. Rim areas and disc sizes were measured via confocal scanning laser ophthalmoscopy. Global and the six sectors’ averages were recorded.
G1 consisted of 141 subjects, G2 consisted of 89, and G3 consisted of 48. The sex distribution (p = 0.112) and mean age (p = 0.129) of the groups were similar. The mean global averages of the standard RNFLs were 96 ± 14.4 µ in G1, 93.8 ± 12.9 µ in G2, and 86 ± 11.8 µ in G3. The mean global averages of the APS-RNFLs were 103.9 ± 97 µ in G1, 103.3 ± 10.6 µ in G2, and 102 ± 10.6 µ in G3. The mean global averages of the BMO-MRW were 374.4 ± 57.7 µ in G1, 373.2 ± 62.2 µ in G2, and 351.9 ± 63.9 µ in G3. For the global averages, APS-RNFL and BMO-MRW did not detect any difference between the three groups (p = 0.563, p = 0.089, respectively), but the standard RNFL did (p < 0.001). Standard RNFL and APS-RNFL were found to be well correlated; however, the correlations between BMO-MRW and standard RNFL or APS-RNFL were either absent or very weak. All three methods showed weak but significant negative correlations with high myopic spherical RE, especially those in the standard RNFL. Moderately negative correlations were found between BMO-MRW and disc size in all sectors (highest in the nasal sector; r = -0.387, p < 0.001). However, there was almost no significant relationship between disc size and standard RNFL or APS-RNFL. Moderately significant negative correlations were observed between the groups categorically and standard RNFL in almost all sectors, while this was much less with APS-RNFL and was not observed in almost any sector with BMO-MRW.
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Original articleEvaluation of the Nerve Fiber Layer and Macula in the Eyes of Healthy Children Using Spectral-Domain Optical Coherence Tomography

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Study Group

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

J AAPOS

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

J AAPOS

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

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Original article
Evaluation of the Nerve Fiber Layer and Macula in the Eyes of Healthy Children Using Spectral-Domain Optical Coherence Tomography