Pediatric Optical Coherence Tomography in Clinical Practice—Recent Progress

Abstract

Citation: Lee H, Proudlock FA, Gottlob I. Pediatric optical coherence tomography in clinical practice-recent progress. Invest Ophthalmol Vis Sci. 2016;57:OCT69-OCT79. DOI:10.1167/iovs.15-18825 PURPOSE. Optical coherence tomography (OCT) has revolutionized the diagnosis and management of adult retinal and optic nerve disease. Children were deprived of this technology until the recent development of handheld spectral-domain OCT (HH-SDOCT). In this article, we review the applications of OCT imaging in pediatric ophthalmology.METHODS. This study was a review of the literature.RESULTS. The acquisition and interpretation of pediatric tomograms differ significantly from those for adults, with adjustments needed to account for the shorter axial lengths, higher refractive errors, and ongoing retinal and optic nerve development in the pediatric eye. Handheld SDOCT is increasingly being used as an adjunctive diagnostic tool in retinopathy of prematurity (ROP) and nonaccidental injury (NAI) by providing additional morphologic information that is not normally clinically discernible. The role of HH-SDOCT in streamlining diagnosis in infantile nystagmus syndrome, retinal dystrophies, and degenerations has been established. Optical coherence tomography can also help differentiate between pediatric intraocular tumors, for example, hamartomas and retinoblastoma; monitor tumor progression; and monitor treatment response. In addition, HH-SDOCT is establishing its role as a noninvasive monitoring tool in children affected by optic nerve pathology such as glaucoma, optic nerve atrophy and hypoplasia, optic pathway glioma, and pseudotumor cerebri. CONCLUSIONS.Handheld SDOCT can provide novel insights into the natural history of retinal and optic nerve diseases in young children. For example, in achromatopsia and albinism, in vivo OCT studies have provided evidence of altered but ongoing retinal development in early childhood, which suggests that potentially targeting treatment at an earlier age may optimize visual function by normalizing retinal development.

Cancer and Central Nervous System Tumor Surveillance in Pediatric Neurofibromatosis 1

“…62,63), are even more promising and may enable early detection of optic nerve damage, especially in early childhood when ophthalmologic examination is difficult. OCT measures the width of the retina and can measure nerve loss even before that is measurable by vision assessment.…”

Optical coherence tomography in paediatric clinical practice

“…Ocular parameters, such as RNFL thickness, ganglion cell layer thickness, retinal and optic disc ultrastructural morphology, as recorded on OCT, vary with age, axial length, refractive error and race. Normal ongoing foveal development continues into adolescence, and correlates with age‐related variations in retinal layer measurements …”

Longitudinal changes in macular retinal layer thickness in pediatric populations: Myopic vs non-myopic eyes

“…The ability of spectral domain optical coherence tomography (SD-OCT) to rapidly and non-invasively acquire high-resolution cross-sectional retinal images, has seen this imaging modality establish itself as an invaluable tool in evaluating the pediatric retina [3]. In-vivo imaging of the pediatric retina with OCT provides detailed morphological data, valuable in the diagnosis, monitoring and grading of a variety of retinal conditions [4–7], and in the assessment and monitoring of the effectiveness of treatments [8–10].…”