Handbook of Pediatric Retinal OCT and the Eye-Brain Connection E-Book

Cynthia A. Toth, Sharon F Freedman, Mays El-Dairi, Lejla Vajzovic

• Publisher: Elsevier
• Year: 2019
• ISBN:
  9780323609852
• Topic: Medicina
• Subtopic: Oftalmología y optometría

Optical Coherence Tomography (OCT) plays a vital role in pediatric retina diagnosis, often revealing unrecognized retinal disorders and connections to brain injury, disease, and delayed neurodevelopment. Handbook of Pediatric Retinal OCT and the Eye-Brain Connection provides authoritative, up-to-date guidance in this promising area, showing how to optimize imaging in young children and infants, how to accurately interpret these images, and how to identify links between these images and brain and developmental disorders.

• Illustrates optimal methods of OCT imaging of children and infants, how to avoid pitfalls, and how to recognize and avoid artifacts
• Explains how the OCT image may relate to brain disease and delayed neurodevelopment
• Features more than 200 high-quality images and scans that depict the full range of disease in infants and young children
• Provides guidance in identifying retinal layers and important abnormalities.
• Covers the structural features of the retina and optic nerve head in developmental, acquired, or inherited conditions that affect the eye and visual pathways
• Offers practical ways to set up imaging programs in the clinic, operating room, or neonatal nursery

Section 1

Introduction to Pediatric Retinal OCT Imaging

Chapter 1

Introduction to OCT Imaging in Infants and Children

Cynthia A. Toth

It has been over 25 years since the development of optical coherence tomography (OCT) and its rapid introduction for ophthalmic use. The first OCT imaging in a young child or in infants was with tabletop time domain OCT systems (Stratus; Carl Zeiss Meditec, Jena, Germany), with children/infants placed under general anesthesia and positioned either prone on an anti-Trendelenburg tilted table, with the neck extended to position on the chin rest,^1,2 or on the side.³ We recognized the need for OCT systems that would enable imaging in the supine infant or child. We thus modified a portable nonhuman spectral domain (SD) OCT system by Bioptigen (now Leica) for investigational human use. In 2009, we published several reports of supine imaging of infants and children: bedside imaging in an awake infant to visualize preretinal neovascularization in aggressive posterior retinopathy of prematurity (ROP)⁴ and imaging of retinal detachment in ROP, macular hole, retinal folds, and epiretinal membrane in infants with nonaccidental trauma, and in a young child with Hermansky-Pudlak syndrome to visualize persisting inner retinal layers in the fovea.^5,6 In each of these cases, the higher speed of SD-OCT has enabled us to capture a volume scan across the macula, ensuring that information about the fovea accurately represents the foveal center. These reports were soon followed by our reports of novel findings in infants based on more widespread use of handheld SD-OCT in awake infants at the bedside. We characterized the stages of preterm infant foveal development, discovered macular cystoid spaces in preterm infants,^7,8 and identified subfoveal fluid in some healthy newborn infants.⁹ At the same time, in India, investigators modified a tabletop SD-OCT system (Spectralis; Heidelberg Engineering, Heidelberg, Germany) for research and also imaged macular cystoid spaces in awake supine preterm infants.¹⁰ By 2012, the U.S. Food and Drug Administration (FDA) cleared the first handheld SD-OCT system for use in neonates (Envisu; Bioptigen/Leica, Morrisville, NC).

From the first applications of OCT in children, OCT images and data have brought new insight into retinal and optic nerve diseases of older children who can cooperate for tabletop imaging. Many eye researchers and specialists have contributed to improving our understanding of the pediatric retina and optic nerve head from birth and throughout childhood through OCT imaging.¹¹ As in adult disease, in pediatric cases, OCT imaging of the optic nerve head and retina captures microanatomic information on tissues that are an extension of the diencephalon. This opens the door for access to information on pathology related to brain injury and brain maldevelopment. In young children, eyes and the brain grow rapidly, and thus the microstructures undergo large developmental changes with growth. Retinal and optic nerve head abnormalities in infants and young children may thus reflect injuries, inherited or acquired diseases, tumors, or even abnormalities in brain development. These are very important considerations in infants and children who, unlike adults, may not be capable of reporting symptoms of disease or injury. The relevant retinal and optic nerve findings relative to the brain are thus highlighted in each chapter in this text.

This text takes a structured look at the advancing field of pediatric OCT imaging. We recognize the unique aspects of retinal and optic nerve head imaging in infants and children and its relationship to brain development and disease. We also address working with children and their families to capture and share images. We have described methods for optimizing scan quality and imaging areas of interest and new modalities, such as swept-source OCT imaging and OCT angiography, and the relevance of OCT imaging across a range of pediatric diseases.

This is an exciting era where every day new imaging discoveries are changing our prior understanding of infant disease—for example, the impact of hypoxic ischemic encephalopathy on the retina, which had not previously been studied because of the difficulty in approaching infants with such diseases for conventional examination. We have been able to perform OCT imaging of the retina in the intensive care nursery, without the need for pharmacologic pupil dilation.¹² Such advances point toward a future of expanded applications for OCT imaging in children. This handbook provides a summary and a roadmap for those working in this field.

References

1 Patel C.K., Chen S.D., Farmery A.D. Optical coherence tomography under general anesthesia in a child with nystagmus. Am J Ophthalmol. 2004;137(6):1127–1129.

2 Patel C.K. Optical coherence tomography in the management of acute retinopathy of prematurity. Am J Ophthalmol....