Reproducibility of Optical Coherence Tomography Measurements in Children

doi:10.1016/j.ajo.2012.06.012

American Journal of Ophthalmology

Volume 155, Issue 1, January 2013, Pages 171-176.e1

https://doi.org/10.1016/j.ajo.2012.06.012 Get rights and content

Purpose

To determine the interobserver and intraobserver reproducibility of a Fourier-domain optical coherence tomography device (Cirrus HD OCT; Carl Zeiss Meditec, Dublin, California, USA) in normal pediatric eyes.

Design

Prospective cross-sectional study.

Methods

One hundred healthy children were recruited prospectively and consecutively. Only 1 randomly chosen eye per subject was included in the study. The eye underwent 3 scans centered on the optic disc and another 3 scans centered on the macula that were acquired by a single operator. A fourth examination was performed by a second operator. Interobserver and intraobserver reproducibility were described by intraclass correlation coefficients (ICCs) and coefficients of variation (COVs).

Results

The mean age was 9.15 years (range, 6.22 to 11.31 years; standard deviation, 1.05 years). Mean retinal nerve fiber layer thickness was 99.53 μm (standard deviation, 10.10 μm), and mean macular thickness was 282.91 μm (standard deviation, 11.83 μm). All the parameters evaluated were highly reproducible. Intraobserver COVs of the retinal nerve fiber layer measurements ranged from 2.24% to 5.52%, and the COV of macular thickness was 0.97%. The intraclass correlation coefficient was greater than 0.8 for all the parameters. The interobserver COV ranged from 2.23% to 5.18%, and the COV of macular thickness was 0.82%. In all the evaluated parameters, the intraclass correlation coefficient was more than 0.75. Repeatability was slightly better in children older than 10 years than in children younger than 9 years.

Conclusions

Retinal nerve fiber layer and macular measurements obtained by Fourier-domain optical coherence tomography showed good repeatability for healthy eyes in the pediatric population. Cirrus HD OCT examinations of the retina are reliable in children.

Section snippets

Methods

This study was undertaken in an elementary school from December 2010 through March 2011 as part of the Environmental Fetal Factors in the Development of the Optic Nerve and the ReTina study (EFFORT). From the 598 eligible children, 358 were included in the study, giving an acceptance rate of 60%. One hundred healthy children were recruited prospectively and consecutively from among the 358 for the reproducibility and repeatability study.¹⁶

All subjects underwent a comprehensive ophthalmologic

Results

One hundred children were included in the study (52 boys and 48 girls). The age of the patients ranged from 6.22 to 11.31 years, with a mean age of 9.15 years. Mean best-corrected visual acuity (logarithm of the minimal angle of resolution) was −0.01 (20/20 Snellen equivalent), with a range from 0.3 to −0.2. The refractive errors ranged from −3.00 to +4.50 of spherical equivalent. Stereoacuity was full (60 seconds of arc or better) in 94 children and was reduced (worse than 60 seconds of arc)

Discussion

OCT is part of daily clinical practice. Reliability and repeatability of diagnostic tools need to be ascertained, especially in children, whose cooperation is limited. Cirrus OCT represents the latest commercially available generation of OCT, with higher axial resolution compared with conventional time-domain OCT. To our knowledge, this is the first report of the study of the reproducibility of the RNFL and macular measurements using high-density FD OCT in healthy children.

Direct comparison of

Irene Altemir, DOO, Bch, MsC, is an optometrist especialist in pediatric population. She completed her Master's degree in 2011 at the Pennsylvania College of Optometry, Salus University in Philadelphia. She has a dedicated pediatric neuro-ophthalmology practice and clinical research program at the Miguel Servet University Hospital in Zaragoza, Spain. Ms Altemir is currently working on her PhD on neurological damage in children.

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Cited by (62)

A Prospective Study of the Effects of General Anesthesia on Intraocular Pressure in Healthy Children
2024, Ophthalmology Science
To determine the effect of general anesthesia on intraocular pressure (IOP) in children with no intraocular pathology and determine which postanesthetic time point is most predictive of preinduction IOP.
Prospective observational study.
Children with no intraocular pathology ≤ 18 years scheduled for general anesthesia as part of their routine care followed by a pediatric ophthalmologist at Nanjing Medical University.
Participants underwent a standardized general anesthetic protocol using a mask induction with sevoflurane and propofol maintenance. Intraocular pressure was measured at the following 7 time points: preinduction (taken in the preoperative area), postinduction minutes 1, 3, and 5, and postairway placement minutes 1, 3, and 5 for a total time period of 10 minutes after induction. A generalized estimating equation was used to evaluate the effect of anesthesia on IOP and the effect of patient factors (age, gender, vital signs, and airway type) on preanesthetic and postanesthetic IOP. An IOP prediction model was developed using the postanesthesia IOP measurements for predicting preinduction IOP.
Intraocular pressure and change in IOP at prespecified time points.
Eighty-five children were enrolled with a mean ± standard deviation (SD) age of 7.5 ± 2.9 years. Mean ± SD preinduction IOP was 20.1 ± 3.7 mmHg. Overall, IOP was lowest at 3 minutes postinduction, decreased to a mean of 13.4 ± 3.7 mmHg (P < 0.001). After this, IOP rose 5 minutes postinduction to 16.5 ± 4.2 mmHg, which did not reach preinduction IOP levels (P < 0.001). The IOP prediction model showed that combining 1 minute postinduction and 3 minutes postairway was most predictive (R² = 0.13), whereas 1 minute postairway was least predictive of preinduction IOP (R² = 0.01).
After the induction of general anesthesia in children, IOP temporarily decreases with a trough at 3 minutes postinduction before increasing and remaining stable just below preinduction levels. Intraocular pressure measurements taken 1 minute after induction with 3 minutes after airway placement are most predictive of preinduction IOP, though predictive value is relatively low.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Evaluation of ganglion cell complex and retinal nerve fiber layer in children with spina bifida using optical coherence tomography
2022, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
The degree of damage to visual pathways causes a decrease in the RNFL thickness, which can hinder visual recovery despite treatment [18]. The repeatability of the decrease in the RNFL thickness in paediatric glaucoma patients compared to healthy children has been observed using several types of SD-OCT devices in previous studies [19,20]. Similarly, in one study in which children with congenital glaucoma were compared with healthy children, decreased thickness of RNFL was shown in both papillary and macular analyses in all sectors in the congenital glaucoma group [21].
Spina bifida (SB) is a congenital disorder caused by the incomplete fusion of the embryonic neural tube during spinal cord development. In this study, we used Spectral Domain Optic Coherence Tomography (SD-OCT) for retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) analyses and compared the results of healthy children and SB patients in a similar age group.
Our study was planned prospectively and conducted between June 2017 and July 2019. One hundred eyes of 50 participants, consisting of 28 SB patients and 22 healthy children were included. In all cases, RNFL and GCC measurements were undertaken using SD-OCT. The circumpapillary RNFL analysis was conducted by examining the circular area of 3.45 mm in diameter around the centre of the optic disc. GCC parameters were determined with MM7 protocols by taking 15 vertical sections from a 7-mm macular square centred in the fovea.
The mean GCC thickness of the participants was 91.120 ± 5.224 µm in the control group and 91.696 ± 7.410 µm in the SB group. The difference between the two groups was not statistically significant (p > 0.05). The mean RNFL thickness was 102.499 ± 11.250 µm in the control group and 99.549 ± 15.235 µm in the SB group. The mean RNFL thickness of the patients in the SB group was lower than that of the control group, but the difference was not statistically significant (p > 0.05).
In this study, the lack of a statistically significant difference in the RNFL and GCC values between the SB and control groups can be attributed to successful clinical management.
Reproducibility of SD-OCT inner macular layer thickness measurements in children with primary congenital glaucoma
2021, Journal Francais d'Ophtalmologie
To examine the reproducibility of spectral domain optical coherence tomography (SD-OCT) segmented ganglion cell complex and circumpapillary retinal nerve fiber layer (cpRNFL) measurements in children with primary congenital glaucoma (PCG) in comparison with healthy children.
12 children with PCG (G1) and 24 healthy children (G2) were recruited. The following SD-OCT measurements (Spectralis, Heidelberg Engineering) were made in one eye per child: total macular thickness (MT), thicknesses in several subfields and volumes of the three inner macular layers, macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) and cpRNFL thickness. In a single day, an expert operator obtained 3 circumpapillary and 3 macular measurements in each participant to determine intraoperator variability. Intraoperator repeatability was defined by the coefficient of variation (CoV) and intraclass correlation (ICC).
ICC was excellent in both groups for cpRNFL measurements (G1 ICC = 0.950 and G2 ICC = 0.995) and for MT was excellent in G1 (ICC= 0.957) and moderate in G2 (ICC = 552). For the inner macular layer measurements, all ICCs were better in PCG group (mRNFL-ICC: 0.915 vs. 0.765; ICC-GCL: 0.584 vs. 0.263 and ICC-IPL: 0.979 vs. 0.742; G1 and G2 respectively). Greater CoV were recorded for macular measurements (from 0.71% to 9.82%) compared to cpRNFL measurements (from 0.52% to 1.50%).
In children with PCG, Spectralis SD-OCT showed excellent intrasession repeatability for cpRNFL, MT, mRNFL and IPL measurements and moderated for GCL measurements. For all macular measurements, ICC were higher in children with PCG than healthy children.
Examiner la reproductibilité des mesures du complexe des cellules ganglionnaires segmentées par tomographie par cohérence optique dans le domaine spectral (SD-OCT) et de la couche de fibres nerveuses circumpapillaires rétiniennes (cpRNFL) chez les enfants atteints de glaucome congénital primitif (GCP) par rapport aux enfants sains.
12 enfants atteints de GCP (G1) et 24 enfants normaux (G2) ont été recrutés. Les mesures SD-OCT suivantes (Spectralis, Heidelberg Engineering) ont été effectuées dans un œil de chaque enfant: épaisseur maculaire totale (MT), épaisseurs dans plusieurs sous-champs et volumes des trois couches maculaires internes, couche des fibres nerveuses rétiniennes maculaires (mRNFL), couche cellulaire ganglionnaire (GCC), et couche plexiforme interne (CPI), et épaisseur du cpRNFL. En une seule journée, un opérateur expert a obtenu 3 mesures circumpapillaires et 3 maculaires chez chaque participant pour déterminer la variabilité intraopératoire. La répétabilité intra-opératoire a été définie par le coefficient de variation (CoV) et la corrélation intraclasse (ICC).
L'ICC était excellente dans les deux groupes pour les mesures de cpRNFL (G1 ICC = 0,950 et G2 ICC = 0,995) et était excellente dans G1 (ICC = 0,957) et modérée dans G2 (ICC = 552) pour la MT. Pour les mesures de la couche maculaire interne, toutes les ICC étaient meilleures dans le groupe GCP (mRNFL-ICC: 0,915 vs 0,765; ICC-GCC: 0,584 vs 0,263 et ICC-CPI: 0,979 vs 0,742; G1 et G2 respectivement). Des CoV plus élevés ont été enregistrés pour les mesures maculaires (de 0,71% à 9,82%) par rapport aux mesures de cpRNFL (de 0,52% à 1,50%).
Chez les enfants atteints de GCP, le Spectralis SD-OCT a montré une excellente répétabilité intra-session pour les mesures de cpRNFL, MT, mRNFL et IPL, et modérée pour les mesures de GCL. Pour toutes les mesures maculaires, les ICC étaient plus élevées chez les enfants atteints de GCP que chez les enfants sains.
Optical coherence tomography imaging of the pediatric retina
2020, Journal of AAPOS
Citation Excerpt :
In cooperative children with ability to fixate and position their chin on the chinrest of a traditional tabletop OCT system, OCT images can be acquired with high reproducibility in the standing or seated position (Figure 1A).1 Stepstools, age-appropriate use of internal or external fixation targets, assistance from parents, and eye-tracking features available on some commercial OCT devices can all aid image acquisition.1 For patients requiring examination under anesthesia and other children for whom supine or other oblique imaging is more optimal, the commercially available Bioptigen/Leica Envisu c2300 (Bioptigen Inc, Research Triangle Park, NC) features a flexible imaging handpiece connected by a cable to a portable spectral domain OCT (SD-OCT) system (Figure 1B).
Optical coherence tomography is an increasingly important part of the retinal specialist's and general ophthalmologist's toolkit for diagnosing and managing retinal disease. This review summarizes the unique considerations and available imaging systems with which pediatric ophthalmologists should be familiar when attempting optical coherence tomography in children. Normal developmental changes in foveal and extrafoveal structure and the need for an established pediatric normative database of retinal thicknesses are reviewed. Finally, applications of optical coherence tomography imaging to selected representative pediatric retinal diseases are introduced as examples of how optical coherence tomography in children is furthering the diagnosis and management of vision-threatening retinal diseases.
Assessment of changes in the macula and optic nerve head using optical coherence tomography in patients with attention deficit hyperactivity disorder
2020, Archivos de la Sociedad Espanola de Oftalmologia
Determinar si existen diferencias en el grosor macular y papilar mediante tomografía de coherencia óptica (OCT) en pacientes con trastorno por déficit de atención e hiperactividad (TDAH) comparando con un grupo control, evaluando además si existen diferencias entre pacientes con TDAH con y sin tratamiento.
Estudio transversal en el que se incluyó a 92 ojos de 46 pacientes, divididos en 2 grupos: 46 ojos de 23 pacientes con TDAH y un grupo control de 46 ojos de 23 sujetos. El grupo de pacientes con TDAH se subdividió en aquellos con tratamiento con metilfenidato o derivados (n = 28) y aquellos sin tratamiento (n = 18). Se midió el grosor macular, el complejo de células ganglionares (CCG) y la capa de fibras nerviosas de la retina (CFNR) a nivel papilar en 12 sectores.
Se observó un menor grosor macular central en los TDAH que en controles (257,4 ± 20 μm vs. 267,5 ± 20 μm; p = 0,013), no observándose diferencias en el CCG (p ≥ 0,566), ni en la CFNR (p ≥ 0,095). En los pacientes con TDAH con y sin tratamiento no se observaron diferencias en el grosor macular ni en el CCG (p ≥ 0,160 y 0,375, respectivamente), pero se objetivó un menor grosor foveal (p = 0,018) y de la CFNR en 5/12 sectores a nivel papilar (p ≤ 0,033) en aquellos sin tratamiento.
Se observó un menor grosor macular en los pacientes con TDAH que en controles. Además, los pacientes con TDAH sin tratamiento presentaron un menor grosor foveal y de la CFNR que aquellos pacientes en tratamiento.
To assess if there are any differences in macular and papillary thickness using optical coherence tomography (OCT) in patients with attention deficit hyperactivity disorder (ADHD) compared with a control group, including if there are differences between ADHD patients with and without treatment.
Prospective observational study including 92 eyes of 46 patients divided into 2 groups: 46 eyes of 23 patients with ADHD, and a control group of 46 eyes of 23 healthy patients. The group of patients with ADHD was subdivided into those on treatment with methylphenidate (n = 28) and those not on treatment (n = 18). The macular thickness, the ganglion cell complex (GCC), and the retinal nerve fibre layer (RNFL) at the papillary level were measured in 12 sectors.
A lower central macular thickness was observed in the ADHD patients than in the controls (257.4 ± 20 μm versus 267.5 ± 20 μm, P=.013), with no differences observed in the GCC (P=.566), or in the RNFL (P=.095). There were no differences in the patients with ADHD with and without treatment, as regards macular thickness and the GCC (P=.160 and P=.375 respectively), but a lower foveal thickness (P=.018) and RNFL in 5/12 sectors at the papillary level (P=.033) were observed in those without treatment.
A lower macular thickness was observed in patients with ADHD than in controls. In addition, patients with ADHD without treatment had a lower thickness of the fovea and RNFL than those patients on treatment.
Paediatric optical coherence tomography normative databases: A real need
2019, Archivos de la Sociedad Espanola de Oftalmologia
La tomografía de coherencia óptica (OCT) se ha convertido en una herramienta imprescindible en las consultas de oftalmología pediátrica. Sin embargo, las OCT disponibles en la actualidad no incluyen ninguna base de datos normativa para población pediátrica, lo que puede conllevar errores importantes de interpretación.
Realizar una revisión bibliográfica sobre las bases de datos normativas para OCT realizadas en población pediátrica.
Se revisan las aplicaciones e implicaciones del uso de las bases de datos normativas pediátricas para OCT.
Se referencian varios estudios realizados para extraer estas bases de datos con diferentes modelos de OCT en población española y europea con el fin de disponer de ellos de manera resumida.
En nuestra práctica clínica diaria es muy importante el conocimiento y manejo de las bases de datos normativas pediátricas para la correcta interpretación de los mapas de grosores de OCT.
Optical coherence tomography (OCT) has become an essential tool in paediatric ophthalmology. However, none of the currently available OCT devices include any kind of normative database for the paediatric population, which can lead to important interpretation errors.
To review the paediatric OCT normative databases.
The applications and implications of the use of paediatric OCT normative databases are reviewed.
The paediatric normative databases that have been published so far in scientific literature with different OCT devices for Spanish and European population are presented.
The knowledge and interpretation of paediatric OCT normative databases in our daily clinical practice is crucial in order for the correct interpretation of OCT thickness maps.

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Original articleReproducibility of Optical Coherence Tomography Measurements in Children

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Prog Retin Eye Res

Ophthalmology

J Fr Ophtalmol

J AAPOS

Ophthalmology

Ophthalmology

Sensitivity advantage of swept Fourier domain optical coherence tomography

Opt Express

Optical coherence tomography imaging of the fovea in retinopathy of prematurity

Ophthalmic Surgery Lasers Imaging

Reproducibility of optic nerve head and retinal nerve fiber layer thickness measurements using optical coherence tomography

Arch Soc Esp Oftalmol

Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using StratusOCT

Invest Ophthalmol Vis Sci

Repeatability and reproducibility of macular thickness measurements with the Humphrey OCT system

Invest Ophthalmol Vis Sci

Intra and interoperator reproducibility of retinal nerve fibre and macular thickness measurements using Cirrus Fourier-domain OCT

Acta Ophthalmol

Reproducibility of nerve fiber layer thickness measurements using 3D Fourier-domain OCT

Invest Ophthalmol Vis Sci

Original article
Reproducibility of Optical Coherence Tomography Measurements in Children