Feasibility and Repeatability of Handheld Optical Coherence Tomography in Children With Craniosynostosis

Abstract

To determine whether handheld optical coherence tomography (OCT) is feasible and repeatable in children with craniosynostosis.Methods: This was a prospective cross-sectional study. Children with syndromic and non-syndromic craniosynostosis 0 to 18 years of age were recruited between February 13, 2020, and October 1, 2020. Main outcome measures included feasibility (patient recruitment and handheld OCT success rates) and repeatability, which were assessed using intraclass correlation coefficients (ICCs) where repeated images of the optic nerve head (ONH) within the same visit were available. ONH parameters used for repeatability analysis included cup depth, width, and area; disc width; rim height; retinal thickness; retinal nerve fiber layer thickness; and Bruch's membrane opening minimum rim width.Results: Fifty children were approached, and all 50 (100%) were successfully recruited. Median age was 51.1 months (range, 1.9-156.9; interquartile range, 37.0-74.2), and 33 of the children (66%) were male. At least one ONH image was obtained in 43 children (86%), and bilateral ONH imaging was successful in 38 children (76%). Factors boosting the likelihood of success included good understanding and cooperation of the child and parent/guardian and availability of an assistant. Repeatability analysis was performed in 20 children, demonstrating good repeatability (ICC range, 0.77-0.99; the majority exceeded 0.90). OCT correctly identified two cases of intracranial hypertension, one of which was undetected by prior fundoscopy. Conclusions:Handheld OCT is feasible and repeatable in children with syndromic and non-syndromic forms of craniosynostosis.Translational Relevance: Our handheld OCT approach could be used for the clinical surveillance of children with craniosynostosis.

Feasibility of a portable optical coherence tomography system in children with craniosynostosis

“…To the best of our knowledge, this is the first study to demonstrate that portable OCT imaging using the Spectralis Flex system is feasible in children with craniosynostosis. The success rates for bilateral and unilateral ONH imaging were similar to those recently obtained at Great Ormond Street Hospital (GOSH), using a handheld OCT device [4], and higher than that reported by Patel et al [5] in a large normative study of children without eye disease (n = 351). This study carried the limitations expected of a feasibility study.…”

Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol

“…Using this technique, all cases with papilloedema were successfully imaged in our recent feasibility and repeatability study. 47 …”

“…Using this technique, all cases with papilloedema were successfully imaged in our recent feasibility and repeatability study. 47 ImageJ V.1.48 (National Institutes of Health, Bethesda, Maryland) 48 shall be used for quantitative segmentation and the ABSnake plugin 49 shall be used identify the internal limiting membrane contour, which can be corrected manually where required. Lateral distance measurements (defined for adults on the machine) shall be corrected to account for the smaller axial lengths in children using a conversion table according to age from the data presented by Maldonado et al 50 Optic nerve and retinal analyses will be based on single B-scans through the deepest part of the optic cup and foveal pit, respectively.…”

“…More recently, we performed a feasibility and repeatability study 47 using handheld OCT in children with craniosynostosis (n=50, median age 51 months, age range 2–157 months). We found good feasibility, with 86% achieving at least unilateral OCT and 76% achieving bilateral OCTs of the ONH.…”

Detection of intracranial hypertension in children using optical coherence tomography: a systematic review

“…Therefore, our group has recently commenced prospective research using handheld OCT in craniosynostosis. 64…”