Foveal vascular development in pediatric eyes assessed using optical coherence tomography angiography

Abstract

Purpose : Examination of pediatric retinal microvasculature and detection of retinal disease may be aided by non-invasive, high-resolution imaging with optical coherence tomography angiography (OCT-A). Normative data may enable differentiation between normal variance and disease in children, and increase understanding of foveal development. We performed a cross-sectional, observational clinical study to quantify normative pediatric OCT-A foveal avascular zone (FAZ) area and provide a comparison to eyes with retinal disease.

Methods : Under IRB protocol, we imaged healthy and diseased maculas of children using investigational Spectralis SD-OCT Flex and tabletop units integrated with OCT-A SP-X1601 algorithm (Heidelberg Engingeering, Heidelberg, Germany) while supine in the operating room or upright in clinic. Poor quality images were excluded. We used Matlab and ImageJ to process and measure FAZ area in 10x10° scan angle and 512 B-scans/volume images, and performed preliminary analysis on the effect of age on FAZ using multivariate analyses and linear regression.

Results : From Sep. to Nov. 2017, we imaged 155 eyes of 91 children with Flex (41 eyes of 27 subjects, mean age 2.8±2yrs, range 10wks-7yrs) and tabletop (114 eyes of 64 subjects, mean age 11.5±3.5yrs, range 5-17). Of the eyes imaged, 74 were healthy and 81 had retinal disease. FAZ area was measured in 59 healthy eyes (Table 1) and was not affected by age (p=0.06, multivariate analysis, and R²=0.06, linear regression). Diseased eyes were qualitatively compared (Fig 1). FAZ was difficult to measure in some eyes with pathology, e.g. Fig. 1 G-H.

Conclusions : We successfully imaged retinal microvasculature in infants and young children using investigational Flex and tabletop OCT-A units in the operating room and clinic. Except for 0-3 years, we found greater variability in foveal vascular development within than across age groups. Future analysis will assess the effect of sex, race/ethnicity, and central foveal thickness on FAZ in children. OCT-A of pediatric maculas may provide a basis for assessing foveal development and pathophysiology.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Table 1. FAZ area (mm²) in healthy pediatric eyes by age measured on OCT-A. Data displayed as mean area±SD (N of eyes).

 

Fig 1. Foveal vasculature in pediatric eyes: A-B) healthy, C) aniridia, D) retinopathy of prematurity, E) preterm, F) familial exudative vitreoretinopathy, G) Coats’ disease, and H) retinoblastoma.