Pediatric Circumpapillary Retinal Nerve Fiber Layer Development in Healthy Infants and Children Using Hand-Held Spectral-Domain Optical Coherence Tomography

Abstract

Purpose : To investigate the development of 3-dimensional full circumpapillary retinal nerve fiber layer (cpRNFL) in full-term infants and young children without sedation and dilation using handheld spectral-domain optical coherence tomography (HH-SDOCT) and also to establish normative age-adjusted values.

Methods : OCT images collected from 375 eyes from 231 infants and children aged between 1 day and 14.5 years using an HH-SDOCT (Leica Microsystems, Envisu C2300, Wetzlar, Germany) system were analyzed semi-automatically using GDx Nerve Fiber Analyzer protocol. The developmental trajectories against log post-menstrual age (logPMA) for cpRNFL thickness (at 6° from the disc center) in four quadrants and ONH parameters mostly approximated to linear changes and were modelled using linear mixed models. Several parameters showed non-linear changes and were modelled using fractional polynomials.

Results : The thickness of superior, inferior and nasal cpRNFL quadrants did not significantly change between birth and 14.5 years old. The 1st quartile (Q1), median (Q2) and 3rd quartile (Q3) were 100 µm, 110 µm and 120 µm for the superior cpRNFL quadrant; 99 µm, 110 µm and 120 µm for the inferior cpRNFL quadrant; and 60 µm, 68 µm and 75 µm for the nasal cpRNFL quadrant, respectively. In contrast, the temporal cpRNFL quadrant demonstrated a significant decrease between birth and approximately 18 months of age and then remained relatively constant up to the age of 14.5 years (Q1 = 57 µm; Q2 = 62 µm; Q3 = 70 µm over 18 months of age).

Conclusions : We describe, for the first time, the development of the full cpRNFL from birth to 14 years using 3-dimensional HH-SDOCT imaging. Interestingly, the temporal cpRNFL quadrant shows a different developmental trajectory to the superior and inferior cpRNFL quadrants despite all three quadrants comprising of fibres projecting from the macular region. Our findings also provide normative data during these critical early years of visual maturation for use in clinical diagnosis, monitoring ocular development and understanding further ocular abnormalities.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.