Retinal Nerve Fiber Layer Thickness in Normal Children Measured with Optical Coherence Tomography

doi:10.1016/j.ophtha.2006.01.036

Ophthalmology

Volume 113, Issue 5, May 2006, Pages 786-791

https://doi.org/10.1016/j.ophtha.2006.01.036 Get rights and content

Purpose

To measure the peripapillary retinal nerve fiber layer (RNFL) thickness in normal children.

Design

Observational cross-sectional study.

Participants

Ninety-two eyes of 92 normal children ages 4 to 17 years presenting to the Ophthalmology Clinic at the Harkness Eye Institute, Department of Ophthalmology, Columbia University.

Methods

Retinal nerve fiber layer thickness was measured with optical coherence tomography (OCT). Patient cooperation and signal strength of the OCT scans were assessed. Optic disc photographs were evaluated by a glaucoma specialist in a masked fashion. Eyes with abnormal optic discs were excluded. One eye of each subject was randomly selected for statistical analysis. The effect of several factors on RNFL thickness was investigated statistically.

Main Outcome Measures

Retinal nerve fiber layer thickness.

Results

Ninety-one percent of the study subjects were Hispanic; 8%, African American; and 1%, Caucasian. Optical coherence tomography measurements were obtained in 117 of 121 (96.7%) subjects, and disc photographs were available for 92 of them. Mean age (±standard deviation [SD]) was 9.7±2.7 years. Mean global RNFL thickness (±SD) was 107.0±11.1 μm (range, 78.1–134.6). The RNFL was thickest inferiorly (136.9±16.9 μm) and superiorly (135.4±19.3 μm), thinner nasally (83.0±18.0 μm), and thinnest temporally (72.5±13.4 μm). In univariate regression analysis, age (P = 0.013) and refraction (P<0.001) had a significant effect on RNFL thickness; age had a significant effect on refraction (P<0.001). When controlling for refraction, age no longer had a significant effect.

Conclusions

Optical coherence tomography can be used to measure RNFL thickness in children. Refraction had an effect on RNFL thickness. In normal children, variation in RNFL thickness is large. The normative data provided by this study may assist in identifying changes in RNFL thickness in children.

Section snippets

Subjects

All subjects were recruited from patients ages 4 to 17 years presenting to the ophthalmology clinic in the Edward S. Harkness Eye Institute (Department of Ophthalmology, Columbia University, New York, New York). To be enrolled, subjects had to have no ocular problems other than refractive error. In particular, children with strabismus or amblyopia were excluded. Also, children with neurological, metabolic, vascular, or other disorders were excluded. All subjects received a full ophthalmic

Demographics

One hundred twenty-one subjects consented to participate in this study. Of these, 4 (3.3%) would not cooperate for the OCT imaging (3 were 4 years old, and 1 was 5). Of the remaining 117 subjects, 20 were excluded because of the lack of disc photographs, 3 because of disc photographs of insufficient quality to assess, 1 because of abnormal discs, and 1 because of pathologic myopia. Thus, 92 subjects were eligible for statistical analysis. After random selection of one eye of each subject, 46

Discussion

In this study, we investigated the peripapillary RNFL thickness in normal children as measured with the latest version of OCT (Stratus OCT). Also, we determined the effects of age, refraction, and other factors on RNFL thickness and evaluated cooperation for OCT measurements among children.

Optical coherence tomography has become a widely used tool in clinical and scientific ophthalmology. However, its use in children has been limited by the lack of normative data, and its feasibility of

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Cited by (150)

The Role of the Retinal Nerve Fiber Layer Thickness on OCT in the Evaluation of Papillitis in Childhood Uveitis
2023, American Journal of Ophthalmology
To investigate the diagnostic value of using retinal nerve fiber layer thickness measured on optical coherence tomography (OCT-RNFL) to diagnose papillitis in pediatric uveitis.
Retrospective cohort study.
Demographic and clinical data were collected retrospectively for 257 children with uveitis (with 455 affected eyes). Receiver operating characteristic (ROC) analysis was performed to compare fluorescein angiography (FA, the diagnostic gold standard for papillitis) to OCT-RNFL in a subgroup of 93 patients. An ideal cut-off value for OCT-RNFL was then determined by calculating the highest Youden index. Finally, a multivariate analysis was applied to the clinical ophthalmological data.
Based on a subset of 93 patients who underwent both OCT-RNFL and FA, the ideal cut-off OCT-RNFL for diagnosing papillitis was >130 µm, with 79% sensitivity and 85% specificity. Among the entire cohort, the prevalence of OCT-RNFL >130 µm was 19% (27/141), 72% (26/36), and 45% (36/80) in patients with anterior uveitis, intermediate uveitis, and panuveitis, respectively. Our multivariate analysis of the clinical data revealed that OCT-RNFL >130 µm was associated with a higher prevalence of cystoid macular edema, active uveitis, and optic disc swelling on fundoscopy, with odds ratios of 5.3, 4.3, and 13.7, respectively (all P < .001).
OCT-RNFL can be a useful noninvasive additional imaging tool for diagnosing papillitis in pediatric uveitis with relatively high sensitivity and specificity. OCT-RNFL was >130 µm in approximately one-third of all children with uveitis and was particularly prevalent in cases of intermediate uveitis and panuveitis.
Visual field indices in children and adults with comparable retinal nerve fiber layer thickness
2023, Journal of AAPOS
To compare visual field indices in normal children and adults with similar retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT).
This cross-sectional study included 59 eyes of 59 normal children 6-18 years of age compared to normal adults. The children underwent visual field testing on the Humphrey Field Analyzer (HFA) and RNFL thickness measurement on OCT. Normal adults who had undergone OCT and visual field testing were retrieved from the OCT database. The mean deviation (MD) in each child was compared with the MD in RNFL thickness–matched eyes of normal adults. Children 6-11 years and 12-18 years were analyzed separately.
Overall, the MD of children was significantly less than that of the normal adults despite having the same RNFL thickness (−2.42 ± 1.42 dB vs −1.61 ± 1.47 dB [P = 0.006]). When stratified by age, the difference in MD of children <12 years was significantly less than normal adults (−2.72 ± 1.5dB vs −1.53 ± 1.2 dB [P = 0.003) while in children >12 years, the difference did not reach statistical significance (−2.18 ± 1.2 vs −1.51 ± 1.32 [P = 0.12]).
In our study cohort, children <12 years had lower visual field indices than adults. Their visual fields may appear worse than they would for an adult with the same RNFL thickness. Normal children >12 years of age seem to have a retinal sensitivity comparable to the adult normative database. It is worthwhile to consider the development of a separate pediatric normative database for the visual field assessment of children <12 years of age.
Optical coherence tomography angiography evaluation of retinal and optic disc microvascular morphological characteristics in retinal vein occlusion
2023, Photodiagnosis and Photodynamic Therapy
To evaluate microvascular morphological characteristics of the retina and optic disc (OD) in retinal vein occlusion (RVO) patients using optical coherence tomography angiography (OCTA), compare the results to age- and gender-matched healthy subjects, and determine correlations between OCTA parameters and best-corrected visual acuity (BCVA) and age.
In this retrospective study, right eyes of 53 RVO patients and 51 healthy subjects were compared regarding BCVA, as well as superficial and deep capillary plexus (SCP and DCP) vessel densities (VDs), foveal avascular zone (FAZ) parameters, outer retinal and choriocapillaris flow areas, OD whole and peripapillary VDs, and retinal nerve fiber layer thickness (RNFLT). Retinal vein occlusion patients were further divided into subgroups based on therapy and risk factors, and OCTA parameters were compared.
Retinal vein occlusion rate or OCTA parameters did not differ significantly by gender (p > 0.05). Retinal vein occlusion patients had significantly decreased BCVA, whole, parafoveal and perifoveal SCP and DCP VDs, as well as VDs 300 µm area around FAZ (FD-300) than healthy subjects (p < 0.001). Their choriocapillaris flow area, RNFLT, whole and peripapillary VDs were also affected. However, FAZ area did not differ significantly between groups. Superior RNFLT (p = 0.016) and whole peripapillary VD (p < 0.001) differed significantly between laser photocoagulation-treated and non-treated patients. The remaining OCTA parameters revealed no significant differences
The RVO and its therapeutic alternatives may affect both OD and retinal VDs. Given its numerous benefits, it seems that OCTA will be used more frequently in clinics for RVO diagnosis, monitoring, and therapeutic response evaluation.
Longitudinal Changes in Vision and Retinal Morphology in Wolfram Syndrome
2022, American Journal of Ophthalmology
To report long-term ophthalmic findings in Wolfram syndrome, including rates of visual decline, macular thinning, retinal nerve fiber layer (RNFL) thinning, and outer plexiform layer (OPL) lamination.
Single-center, cohort study.
A total of 38 participants were studied, who underwent a complete ophthalmic examination as well as optical coherence tomography imaging of the macula and nerve on an annual basis. Linear mixed-effects models for longitudinal data were used to examine both fixed and random effects related to visual acuity and optic nerve quadrants of RNFL and macula thickness.
Participants completed a mean of 6.44 years of follow-up (range 2-10 years). Visual acuity declined over time in all participants, with a mean slope of 0.059 logMAR/y (95% CI = 0.07-0.05 logMAR/y), although nearly 25% of participants experienced more rapid visual decline. RNFL thickness decreased in superior, inferior, and nasal quadrants (β = −0.5 µm/y, −0.98 µm/y, −0.28 µm/y, respectively). OPL lamination was noted in 3 study participants, 2 of whom had autosomal dominant mutations.
Our study describes the longest and largest natural history study of visual acuity decline and retinal morphometry in Wolfram syndrome to date. Results suggest that there are slower and faster progressing subgroups and that OPL lamination is present in some individuals with this disease.
Prematurity: a medical history of obligatory consideration when assessing the retinal ganglion cell complex
2022, Archivos de la Sociedad Espanola de Oftalmologia
La supervivencia de los niños prematuros es cada vez más frecuente siendo cada vez más habitual encontrar pacientes con este antecedente en las consultas de oftalmología. El parto prematuro puede conllevar cambios estructurales a nivel ocular, pudiéndose afectar entre otras estructuras el complejo de células ganglionares (CCG), que puede ser estudiado mediante la tomografía de coherencia óptica.
Realizar una revisión bibliográfica de los estudios que analizan el CCG en pacientes con antecedente de prematuridad y lo comparan con pacientes nacidos a término.
Se referencian varios estudios que analizan el CCG en población con antecedente de prematuridad y se estudian los distintos resultados obtenidos.
En nuestra práctica clínica, conocer el antecedente de prematuridad es fundamental en la valoración del CCG medido por tomografía de coherencia óptica ya que el grosor de esta capa es distinta en la población con antecedente de prematuridad comparada con la población a término.
Premature children birth and survival is becoming more frequent due to the improvement in obstetric and neonatal care. This makes it increasingly common to find patients with history of preterm birth in ophthalmology clinics, both in pediatric and adult ages. Premature birth can lead to ocular structural changes, being possible to affect the ganglion cell complex (GCC), among other structures, which can be studied using optical coherence tomography.
To carry out a bibliographic review of the studies that analyze GCC in patients with a history of prematurity compared with patients born at term.
Several studies that analyze GCC in patients with a history of prematurity are referenced and their results are studied.
In our clinical practice, knowing the history of prematurity is fundamental in the assessment of GCC measured by optical coherence tomography, since this layer is different in the patients with a history of prematurity compared to patients born at term.
Sex-Specific Differences in Circumpapillary Retinal Nerve Fiber Layer Thickness
2020, Ophthalmology
To investigate the role of sex on retinal nerve fiber layer (RNFL) thickness at 768 circumpapillary locations based on OCT findings.
Population-based cross-sectional study.
We investigated 5646 eyes of 5646 healthy participants from the Leipzig Research Centre for Civilization Diseases (LIFE)-Adult Study of a predominantly white population.
All participants underwent standardized systemic assessments and ocular imaging. Circumpapillary RNFL (cRNFL) thickness was measured at 768 points equidistant from the optic nerve head using spectral-domain OCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany). To control ocular magnification effects, the true scanning radius was estimated by scanning focus. Student t test was used to evaluate sex differences in cRNFL thickness globally and at each of the 768 locations. Multivariable linear regression and analysis of variance were used to evaluate individual contributions of various factors to cRNFL thickness variance.
Difference in cRNFL thickness between males and females.
Our population consisted of 54.8% females. The global cRNFL thickness was 1 μm thicker in females (P < 0.001). However, detailed analysis at each of the 768 locations revealed substantial location specificity of the sex effects, with RNFL thickness difference ranging from –9.98 to +8.00 μm. Females showed significantly thicker RNFLs in the temporal, superotemporal, nasal, inferonasal, and inferotemporal regions (43.6% of 768 locations), whereas males showed significantly thicker RNFLs in the superior region (13.2%). The results were similar after adjusting for age, body height, and scanning radius. The superotemporal and inferotemporal RNFL peaks shifted temporally in females by 2.4° and 1.9°, respectively. On regions with significant sex effects, sex explained more RNFL thickness variance than age, whereas the major peak locations and interpeak angle explained most of the RNFL thickness variance unexplained by sex.
Substantial sex effects on cRNFL thickness were found at 56.8% of all 768 circumpapillary locations, with specific patterns for different sectors. Over large regions, sex was at least as important in explaining the cRNFL thickness variance as was age, which is well established to have a substantial impact on cRNFL thickness. Including sex in the cRNFL thickness norm could therefore improve glaucoma diagnosis and monitoring.

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Manuscript no. 2005-623.

Supported by a Career Development Award from Research to Prevent Blindness, New York, New York (MFC), and by the National Eye Institute, Bethesda, Maryland (grant no.: EY13972 [MFC]).

The authors have no financial interest in the devices or techniques used in the study.

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Original ArticleRetinal Nerve Fiber Layer Thickness in Normal Children Measured with Optical Coherence Tomography

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Subjects

Demographics

Discussion

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Optical coherence tomography

Science

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

Invest Ophthalmol Vis Sci

Original Article
Retinal Nerve Fiber Layer Thickness in Normal Children Measured with Optical Coherence Tomography