Evaluation of Normal Human Foveal Development Using Optical Coherence Tomography and Histologic Examination

Abstract

Objective Assess outer retinal layer maturation during late gestation and early postnatal life using optical coherence tomography (OCT) and histology. Methods Thirty-nine subjects ranging from 32 weeks post-menstrual age (PMA) to 4 years were imaged using a hand held OCT (102 imaging sessions). Foveal images from 16 subjects (21 imaging sessions) were normal and evaluated for inner retinal excavation and presence of outer retinal reflective bands. Reflectivity profiles of central, parafoveal, and perifoveal retina were extracted and compared to age-matched histological sections. Results Foveal pit morphology in infants was generally distinguishable from adults. Reflectivity profiles showed a single hyper-reflective band at the fovea in all infants less than 42 weeks PMA. Multiple bands were distinguishable in the outer retina at the perifovea by 32 weeks PMA, and at the fovea by 3 months post term. By 17 months postnatal the characteristic appearance of four hyper-reflective bands was evident across the foveal region. These features are consistent with previous results from histology. A ‘temporal divot’ was present in some infants and foveal pit morphology and extent of inner retinal excavation was variable. Conclusions Hand-held OCT imaging is a viable technique for evaluating neonatal retinas. In premature infants, who do not develop ROP, the foveal region appears to follow a developmental time course similar to in utero maturation. Clinical Relevance As pediatric OCT imaging becomes more common, a better understanding of normal foveal and macular development is needed. Longitudinal imaging offers the opportunity to track postnatal foveal development in preterm infants where poor visual outcomes are anticipated or to track treatment outcomes in this population.

In Vivo Foveal Development Using Optical Coherence Tomography

“…19 It is hypothesized that mechanical stretching of the retina caused by growth of the eye drives migration of the inner retinal layers away from the fovea. 24 The largest change in axial length (reflecting eye growth) occurs during the first 24 months of life, when the axial length reaches 90% of mean adult values.…”

“…12,16,17 Foveal development has been reported to be completed between 11 months and 5 years of age. 12,13,18,19 In contrast, it has been shown that visual functions increase until adulthood, which has been attributed to maturation of the visual cortex. 20 The aim of this study was to determine the developmental time course and trajectories for each retinal layer at the fovea and define the contribution of each retinal layer to the development of normal vision in full-term infants and young children using HH-SDOCT.…”

Feasibility of Macular Integrity Assessment (MAIA) Microperimetry in Children: Sensitivity, Reliability, and Fixation Stability in Healthy Observers

“…37,38 Instead, Tschopp et al 35 suggested that age differences in perimetry may be due to gradual maturation in selective visual attention, with the need to fixate a central fixation target causing a form of ''cognitive tunnel vision'' in younger children. The pattern of sensitivity estimates observed in the present study are consistent with this hypothesis, in that children's deficit was most pronounced at more eccentric locations (38 and 58) and smaller around the center (18,08).…”

Lateral and axial measurement differences between spectral-domain optical coherence tomography systems

“…We decided to evaluate two commercial platforms that are commonly used in human adult imaging, clinical research, and randomized clinical trials. [2][3][4] We chose a commercial hand-held portable platform approved for retinal imaging in pediatric human subjects 5,14,[20][21][22] and in basic animal research. [23][24][25] Furthermore, the largest ongoing randomized trial for age-related macular degeneration (AMD), the NEI-sponsored Age-Related Eye Disease Study 2, exclusively allows the Bioptigen SDOIS platform for its longitudinal, observational ancillary SDOCT study (AREDS2 Ancillary SDOCT Study).…”