Inner macular layer thickness by spectral domain optical coherence tomography in children and adults: a hospital-based study

Sensitivity, Specificity, and Cutoff Identifying Optic Atrophy by Macular Ganglion Cell Layer Volume in Syndromic Craniosynostosis

PURPOSE

To determine the sensitivity, specificity, and cutoff of macular ganglion cell layer (GCL) volume consistent with optic atrophy in children with syndromic craniosynostosis and to investigate factors independently associated with reduction in GCL volume.

DESIGN

Retrospective cross-sectional study.

PARTICIPANTS

Patients with syndromic craniosynostosis evaluated at Boston Children's Hospital (2010-2022) with reliable macular OCT scans.

METHODS

The latest ophthalmic examination that included OCT macula scans was identified. Age at examination, sex, ethnicity, best-corrected logarithm of the minimum angle of resolution (logMAR) visual acuity, cycloplegic refraction, and funduscopic optic nerve appearance were recorded in addition to history of primary or recurrent elevation in intracranial pressure (ICP), Chiari malformation, and obstructive sleep apnea (OSA). Spectral-domain OCT software quantified segmentation of macula retinal layers and was checked manually.

MAIN OUTCOME MEASURES

The primary outcome was determining sensitivity, specificity, and optimal cutoff of GCL volume consistent with optic atrophy. The secondary outcome was determining whether previously elevated ICP, OSA, Chiari malformation, craniosynostosis diagnosis, logMAR visual acuity, age, or sex were independently associated with lower GCL volume.

RESULTS

Median age at examination was 11.9 years (interquartile range, 8.5-14.8 years). Fifty-eight of 61 patients (112 eyes) had reliable macula scans, 74% were female, and syndromes represented were Apert (n = 14), Crouzon (n = 17), Muenke (n = 6), Pfeiffer (n = 6), and Saethre-Chotzen (n = 15). Optimal cutoff identifying optic atrophy was a GCL volume < 1.02 mm3 with a sensitivity of 83% and specificity of 77%. Univariate analysis demonstrated that significantly lower macular GCL volume was associated with optic atrophy on fundus examination (P < 0.001), Apert syndrome (P < 0.001), history of elevated ICP (P = 0.015), Chiari malformation (P = 0.001), OSA (P < 0.001), male sex (P = 0.027), and worse logMAR visual acuity (P < 0.001). Multivariable median regression analysis confirmed that only OSA (P = 0.005), optic atrophy on fundus examination (P = 0.003), and worse logMAR visual acuity (P = 0.042) were independently associated with lower GCL volume.

CONCLUSIONS

Surveillance for optic atrophy by GCL volume may be useful in a population where cognitive skills can limit acquisition of other key ophthalmic measures. It is noteworthy that OSA is also associated with lower GLC volume in this population.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Assessment of macular choroidal and retinal thickness: a cohort study in Tibetan healthy children

This research investigates the distribution, progressive changes, and contributing factors of macular choroidal and retinal thickness in Tibetan children utilizing swept-source optical coherence tomography (SS-OCT). The Lhasa childhood study recruited 1632 students from seven primary schools in Lhasa. These participants underwent OCT and ophthalmological evaluations, encompassing retinal and choroidal thickness measurements, refractive error, axial length (AL), and systemic examinations. The median age of the scholars was 8.57 ± 0.50 years with a median spherical equivalent (SE) of 0.19 ± 1.28D. Multivariate regression analysis revealed that thinner macular choroid thickness was correlated with lower value of SE, worse best-corrected visual acuity, higher mean arterial blood pressure (MABP) and boys, while retinal thickness was associated with better image quality and lower value of SE. The choroid and retina were significantly thinner in myopic children. SE was positively related to the thickness of all choroidal and full retinal subregions. In comparison to baseline data from 20 months prior, most regions of the full retina had significantly thinned. Choroidal thickness of Tibetan children is thinner than that of same-age children from other regions. Thinning of retina, the outer-sector GCC and GCIPL may be specified as a follow-up and prognostic indicator for myopia.

Cone contrast test-HD: sensitivity and specificity in red-green dichromacy and the impact of age

We report normative cone contrast sensitivity values, right-left eye agreement, and sensitivity and specificity values for the cone contrast test-HD (CCT-HD). We included 100 phakic eyes with color vision normal (CVN) and 20 dichromatic eyes (10 with protanopia and 10 with deuteranopia). The CCT-HD was used to measure L, M, and S-CCT-HD scores, and the right and left eyes were evaluated for agreement using Lin's concordance correlation coefficient (CCC) and Bland-Altman analysis to investigate the sensitivity and specificity of the CCT-HD based on diagnosis with an anomaloscope device. All cone types were in moderate agreement with the CCC (L-cone: 0.92, 95% CI, 0.86-0.95; M-cone: 0.91, 95% CI, 0.84-0.94; S-cone: 0.93, 95% CI, 0.88-0.96), whereas the Bland-Altman plots showed that the majority of cases (L-cone: 94%; M-cone: 92%; S-cone: 92%) fell within the 95% limits of agreement and showed good agreement. The m e a n±s t a n d a r d error L, M, and S-CCT-HD scores for protanopia were 0.6±1.4, 74.7±2.7, and 94.6±2.4, respectively; for deuteranopia, these were 84.0±3.4, 40.8±3.3, and 93.0±5.8, respectively; and for age-matched CVN eyes (m e a n±s t a n d a r d deviation age, 53.1±5.8 years; age range, 45-64 years), these were 98.5±3.4, 94.8±3.8, and 92.3±3.4, respectively, with significant differences between the groups except for S-CCT-HD score (Bonferroni corrected α=0.0167, p<0.0167). The sensitivity and specificity of the CCT-HD were 100% for protan and deutan in diagnosing abnormal types in those aged 20 to 64 years; however, the specificity decreased to 65% for protan and 55% for deutan in those aged >65 years. The CCT-HD is comparable to the diagnostic performance of the anomaloscope in the 20-64-year-old age group. However, the results should be interpreted cautiously in those ≥65 years, as these patients are more susceptible to acquired color vision deficiencies due to yellowing of the crystalline lens and other factors.

Optical coherence tomography in the diagnosis and monitoring of congenital and juvenile glaucoma

Optical coherence tomography (OCT) in everyday routine practice is the method of choice for the instrumental diagnosis of glaucoma in adults. As a non-invasive and safe method of visualizing structural changes in the retina and the optic nerve, the method is of particular value in pediatric practice. At the same time, OCT diagnostics in children is associated with certain difficulties, both during the study and when interpreting the scan results.

This review summarizes the data from the literature and our own research in the diagnosis and monitoring of congenital and juvenile glaucoma from the standpoint of our own long-term clinical experience in using optical coherence tomography. We consider the physiological changes of the retina and optic nerve, attention is focused on the need to create a pediatric regulatory database of retinal thickness, the factors that determine the normal range of the data obtained and allow distinguishing physiological processes from pathological ones are identified. Clinical cases confirming the value of OCT in combined pathology are presented as examples.

Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery

Purpose: To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye.Conclusions: Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.

Agreement and differences between macular values in children using two types of spectral optical coherence tomography

OBJECTIVES

To determine the degree of agreement and differences between macular parameters according to sex, age, laterality, ethnicity and type of optical coherence tomography (OCT) in paediatric patients.

MATERIALS AND METHODS

Prospective, transversal, and comparative study. OCT Spectralis and OCT Cirrus were used to obtain the macular values of both eyes in 100 patients between 5 and 15 years without ocular pathology. Due to the similarity between the values of both eyes, in the final sample we only considered the right eyes (OD) (n = 100).

RESULTS

The average central macular thickness (CMT) was 244.2 μm with Cirrus and 261.7 μm with Spectralis. The degree of agreement for the GMC was moderate (Intraclass Correlation Coefficient: 0.66) and from low to very low in the other quadrants. The GMC values of both systems were significantly higher in men than in women (P < .05). The macular retinal nerve fibre layer (mRNC), ganglion cell layer (GCC), the inner plexiform layer (IPLC), and the inner nuclear layer (INFL) had significantly higher values in men than in women (P < .01). There were no statistically significant differences in the GMC by age and laterality, however it was significantly higher in ethnic European children than in ethnic Latin American children; Cirrus (P = .042) and Spectralis (P = .033).

CONCLUSIONS

Macular parameters obtained by OCT Spectralis and OCT Cirrus should not be interchangeable in pediatric patients.

Impact of ocular dominance on circumpapillary and macular retinal nerve fibre layer thickness and ganglion cell layer thickness in a healthy pediatric population

OBJECTIVE

This study was designed to evaluate potential differences in circumpapillary retinal nerve fibre layer (cpRNFL) thickness and segmented macular retinal layers between dominant and nondominant eyes on spectral-domain optical coherence tomography in a pediatric population.

DESIGN

Cross-sectional study.

PARTICIPANTS

89 healthy children attending a general pediatric clinic.

METHODS

Participants underwent sighting dominant testing and macular and cpRNFL spectral-domain optical coherence tomography. Segmented macular layer thicknesses and cpRNFL thickness were compared for individual patients based on their ocular dominance.

RESULTS

Ocular dominance occurred particularly in the right eye (64.7%). Dominant and nondominant eyes did not differ significantly in axial length or spherical equivalent refraction; axial length: 22.99 ± 1.17 mm versus 22.98 ± 1.19 mm; p = 0.51 and spherical equivalent refraction: -0.09 ± 2.68 D versus 0.32 ± 2.93 D; p = 0.41. In the comparison of the macular ganglion layer the average thickness in the 1 mm central Early Treatment Diabetic Retinopathy Study area was significantly different between the dominant and nondominant eye (16.56 ± 6.02 μm vs 17.58 ± 8.32 μm; p = 0.02). However, when compensating with Bonferroni, this difference was no longer statistically significant. There were no differences in the analyses of average global and sectorial cpRNFL thickness in dominant and nondominant eyes.

CONCLUSION

Dominant eyes demonstrated no significantly thicker average macular retinal nerve fiber layer (mRNFL), Ganglion cell layer (GCL) thickness or cpRNFL thickness. No ocular characteristic was found to be associated with the relative dominance of an eye in eyes with low anisometropia.

Agreement and differences between macular values in children using two types of spectral optical coherence tomography

OBJECTIVE

To determine the degree of agreement and differences between macular parameters according to sex, age, laterality, ethnicity and type of optical coherence tomography (OCT) in paediatric patients.

MATERIALS AND METHODS

Prospective, transversal, and comparative study. OCT Spectralis and OCT Cirrus were used to obtain the macular values of both eyes in 100 patients between 5 and 15years without ocular pathology. Due to the similarity between the values of both eyes, in the final sample we only considered the right eyes (OD) (n=100).

RESULTS

The average central macular thickness (CMT) was 244.2μm with Cirrus and 261.7μm with Spectralis. The degree of agreement for the GMC was moderate (intraclass correlation coefficient: 0.66) and from low to very low in the other quadrants. The GMC values of both systems were significantly higher in men than in women (P<.05). The macular retinal nerve fibre layer (mRNC), ganglion cell layer (GCC), the inner plexiform layer (IPLC), and the inner nuclear layer (INFL) had significantly higher values in men than in women (P<.01). There were no statistically significant differences in the GMC by age and laterality, however it was significantly higher in ethnic European children than in ethnic Latin American children; Cirrus (P=.042) and Spectralis (P=.033).

CONCLUSIONS

Macular parameters obtained by OCT Spectralis and OCT Cirrus should not be interchangeable in pediatric patients.

Pupillary light reflex in ethambutol-induced optic neuropathy

We evaluated changes in the pupillary light reflex (PLR) of ethambutol (EMB)-induced optic neuropathy and analyzed the correlations between PLR parameters and other structural changes in EMB-induced optic neuropathy. This retrospective, observational, case–control study involved thirty-two eyes of 17 patients with EMB-induced optic neuropathy (EON group), sixty eyes of 60 patients without EMB-induced optic neuropathy (non-EON group) while taking ethambutol, and forty-five eyes of 45 normal controls. PLR was measured by digital pupillometry. The clinical characteristics, optical coherence tomography measurements and PLR parameters including pupil diameter, constriction latency, constriction ratio/velocity, and dilation velocity were noted. The differences in PLR measurements were compared among the three groups. Correlations between PLR parameters and other structural parameters in EMB-induced optic neuropathy were evaluated. The pupillary constriction ratio, constriction and dilation velocities were significantly reduced in the EON group compared to the non-EON group and controls (all P < 0.05). In EMB-induced optic neuropathy, average outer macular ganglion cell layer (mGCL) thickness showed a significant correlation with the pupillary constriction ratio (ß = 4.14, P = 0.003) and maximal constriction velocity (ß = 1.08, P < 0.001). This study confirmed that pupillary constriction and dilation velocities were significantly decreased in patients with EMB-induced optic neuropathy, compared to normal controls. Digital pupillometry may be a useful tool in the evaluation of EMB-induced optic neuropathy.

Focal alteration of the intraretinal layers in neurodegenerative disorders

Focal intraretinal alterations have been studied to advance our understanding of the pathology of neurodegenerative diseases. The current literature involving focal alterations in the intraretinal layers was reviewed through PubMed using the search terms "focal alteration", "region of interest", "optical coherence tomography", "glaucoma", "multiple sclerosis", "Alzheimer's disease", "Parkinson disease", "neurodegenerative diseases" and other related items. It was found that focal alterations of intraretinal layers were different in various neurodegenerative diseases. The typical focal thinning might help differentiate various ocular and cerebral diseases, track disease progression, and evaluate the outcome of clinical trials. Advanced exploration of focal intraretinal alterations will help to further validate their clinical and research utility.

Association between myopia and peripapillary hyperreflective ovoid mass-like structures in children

We investigated the characteristics of children with peripapillary hyperreflective ovoid mass-like structures (PHOMS) and evaluated the associated risk factors. This cross-sectional study included 132 eyes of 66 children with PHOMS and 92 eyes of 46 children without PHOMS (controls) who were assessed by disc enhanced-depth image spectral-domain (SD) optical coherence tomography (OCT). Univariable and multivariable logistic analyses were performed to evaluate risk factors associated with presence of PHOMS. Among the 66 children with PHOMS, 53 (80.3%) had bilateral and 13 (19.7%) had unilateral PHOMS. The mean age of the PHOMS group was 11.7 ± 2.6 years, and that of the control group was 11.4 ± 3.1 years. The mean spherical equivalent (SE) as determined by cycloplegic refraction was −3.13 ± 1.87 diopters (D) in the PHOMS group and −0.95 ± 2.65 D in the control group. Additionally, mean astigmatism was 0.67 ± 0.89 D and 0.88 ± 1.02 D in the PHOMS group and the control group, respectively. Mean disc size was 1,735 ± 153 µm in the PHOMS group and 1,741 ± 190 µm in the control group, while mean optic nerve head (ONH) tilt angle was 9.84 ± 5.38 degrees in the PHOMS group and 3.71 ± 4.41 degrees in the control group. SE and ONH tilt angle were significantly associated with PHOMS according to both univariable [odds ratio (OR): 1.59; p < 0.001 and OR: 1.35; p < 0.001, respectively] and multivariable (OR: 1.71; p = 0.001 and OR: 1.29; p = 0.001, respectively) logistic regression analyses. There was a significant correlation between SE and ONH tilt (r = −0.46; p < 0.001). In conclusion, PHOMS is associated with myopic shift in children, and optic disc tilt may be a mediator between myopia and PHOMS.

Juvenile Batten Disease (CLN3): Detailed Ocular Phenotype, Novel Observations, Delayed Diagnosis, Masquerades, and Prospects for Therapy

Purpose

To characterize the retinal phenotype of juvenile neuronal ceroid lipofuscinosis (JNCL), highlight delayed and mistaken diagnosis, and propose an algorithm for early identification.

Design

Retrospective case series.

Participants

Eight children (5 female) with JNCL.

Methods

Review of clinical notes, retinal imaging including fundus autofluorescence and OCT, electroretinography (ERG), and both microscopy and molecular genetic testing.

Main Outcome Measurements

Demographic data, signs and symptoms, visual acuity (VA), fundus autofluorescence and OCT findings, ERG phenotype, and microscopy/molecular genetics.

Results

Participants presented with rapid bilateral vision loss over 1 to 18 months, with mean VA deteriorating from 0.44 logarithm of the minimum angle of resolution (logMAR) (range, 0.20–1.78 logMAR) at baseline to 1.34 logMAR (0.30 logMAR - light perception) at last follow-up. Age of onset ranged from 3 to 7 years (mean, 5.3 years). The age at diagnosis of JNCL ranged from 7 to 10 years (mean, 8.3 years). Six children displayed eccentric fixation, and 6 children had cognitive or neurologic signs at the time of diagnosis (75%). Seven patients had bilateral bull’s-eye maculopathy at presentation. Coats-like exudative vasculopathy, not previously reported in JNCL, was observed in 1 patient. OCT imaging revealed near complete loss of outer retinal layers and marked atrophy of the nerve fiber and ganglion cell layers at the central macula. An electronegative ERG was present in 4 patients (50%), but with additional a-wave reduction, there was an undetectable ERG in the remaining 4 patients. Blood film microscopy revealed vacuolated lymphocytes, and electron microscopy showed lysosomal (fingerprint) inclusions in all 8 patients.

Conclusions

In a young child with bilateral rapidly progressive vision loss and macular disturbance, blood film microscopy to detect vacuolated lymphocytes is a rapid, readily accessible, and sensitive screening test for JNCL. Early suspicion of JNCL can be aided by detailed directed history and high-resolution retinal imaging, with subsequent targeted microscopy/genetic testing. Early diagnosis is critical to ensure appropriate management, counseling, support, and social care for children and their families. Furthermore, although potential therapies for this group of disorders are in early-phase clinical trial, realistic expectations are that successful intervention will be most effective when initiated at the earliest stage of disease.