Functional Outcomes of Young Infants With and Without Macular Edema

Abstract

Summary Statement Infants who showed age-appropriate retinal microanatomy on spectral domain optical coherence tomography imaging obtained in the nursery had age-appropriate visual acuities on follow-up as toddlers or school-aged children. By contrast, infants with macular edema on imaging, subsequently demonstrated suboptimal vision, sensorimotor deficits, brain abnormalities, and/or poor neurodevelopment. Purpose We relate posterior segment microanatomy from perinatal spectral-domain optical coherence tomography (SDOCT) to visual acuity (VA), brain abnormalities, and neurodevelopment. Methods Thirteen infants (11 preterm, 2 term birth), imaged in the nursery with portable SDOCT, had VA and sensorimotor testing at age 9-15 months (grating acuity) or 4-5 years (optotype), and medical records reviewed for brain magnetic resonance imaging (MRI) reports and Bayley Scales testing at age 18-24 months. Results Eight children with age-appropriate macular microanatomy without edema on perinatal SDOCT had optimal (>/= 20/40) or within normal limits (grating acuity) VA. Five children with perinatal macular edema had suboptimal VA (in 9/10 eyes) and either sensorimotor deficits, MRI abnormalities or poor neurodevelopment. Macular edema persisted in one infant through 9 months corrected age. Conclusion Maturation of the visual system and evolution of retinal anomalies can be monitored with posterior segment SDOCT. Retinal microanatomy observed in infancy might relate to subsequent vision as well as other central nervous system events, but additional studies are needed to determine the range of normal microanatomy in infants and how this relates to vision and neurodevelopment.

Optical coherence tomography of the preterm eye: from retinopathy of prematurity to brain development

“…Another study followed 13 infants (eleven preterm and two term) imaged in the nursery and found that all eight children with age-appropriate microanatomy on SDOCT had ≥20/40 visual acuity or within the normal limits on Teller acuity cards, while the five infants with CME later had suboptimal acuity, sensorimotor deficits, abnormalities on brain magnetic resonance imaging (MRI), or poor neurodevelopment. 27 Vinekar et al 43 also reported reduced visual acuity as early as 3 months corrected age in infants with CME. This may be due to delayed photoreceptor development for very preterm infants with or without CME 35 or other confounding health parameters in this sick and vulnerable population.…”

“…Vinekar et al26 similarly disassembled an OCT device and used the freed camera to image nonanesthetized eyes. Today, handheld spectral domain (SD)OCT devices allow for noncontact, portable imaging of supine infants at the bedside for both clinical and research purposes 27. The mobile imaging hand piece is attached to a fiber optic cable and can be oriented at the appropriate angle directly above the nonsedated supine eye.…”

“…Bedside spectral domain optical coherence tomography (SDOCT) imaging (with the Envisu, Bioptigen Inc., Research Triangle Park, NC, USA) is performed with the infant supine within his or her incubator or bed, and with the examiner holding the eyelids open and this noncontact system over the eye. Rothman et al27,28 published video links to bedside imaging in the NICU and imaging in the clinic 28. Imaging is first centered on the macula, with a single volume of macula, then a volume across optic nerve and preferably a volume containing both macula and the optic nerve to allow one to draw an organizing axis from optic nerve to fovea 29.…”

“…According to Rothman et al,42 because the neurosensory retina is an extension of the CNS, SDOCT allows for direct visualization of CNS tissue and the CME observed may be an ophthalmologic manifestation of cellular events occurring elsewhere in the brain and CNS. Another study followed 13 infants (eleven preterm and two term) imaged in the nursery and found that all eight children with age-appropriate microanatomy on SDOCT had ≥20/40 visual acuity or within the normal limits on Teller acuity cards, while the five infants with CME later had suboptimal acuity, sensorimotor deficits, abnormalities on brain magnetic resonance imaging (MRI), or poor neurodevelopment 27. Vinekar et al43 also reported reduced visual acuity as early as 3 months corrected age in infants with CME.…”

“…Today, handheld spectral domain (SD)OCT devices allow for noncontact, portable imaging of supine infants at the bedside for both clinical and research purposes. 27 The mobile imaging hand piece is attached to a fiber optic cable and can be oriented at the appropriate angle directly above the nonsedated supine eye. Furthermore, Maldonado et al 28 created an age-dependent model to estimate the axial length of the infant eye, which is required to extrapolate lateral measurements.…”