Overhead Mounted Optical Coherence Tomography in Childhood Glaucoma Evaluation.

PReCIS:: Overhead mounted spectral-domain optical coherence tomography enables high quality imaging of the optic nerve and macula in childhood glaucoma and is particularly useful when standard tabletop optical coherence tomography has failed or is not possible. PURPOSE Tabletop optical coherence tomography, integral to adult glaucoma management, can be limited in childhood glaucoma patients due to young age, poor cooperation, and/or technical challenges. To address these imaging difficulties, we determined the feasibility and quality of an overhead mounted unit in childhood glaucoma. Secondary aims included evaluation of peripapillary retinal nerve fiber layer, parafoveal total retinal thickness, and parafoveal ganglion cell complex thickness. MATERIALS AND METHODS Children and adults with a diagnosis of childhood glaucoma were imaged with overhead mounted spectral-domain optical coherence tomography as part of a prospective cross-sectional study. Participants had poor quality or unobtainable tabletop optical coherence tomography and were scheduled for an examination under anesthesia and/or surgery as part of standard care. RESULTS Eighty-eight affected eyes in 60 of 65 (92.3%) enrolled patients (mean age 5.9±5.9▒y, range 0.2-24.5) were successfully imaged. Mean image quality for analyzed scans was 22.9±6.0 decibels (n=236 images). Mean values for peripapillary retinal nerve fiber layer (80.5±31.0▒µm; n=86), parafoveal total retinal thickness (301.10±39.9▒µm; n=79), and parafoveal ganglion cell complex thickness (96.0±21.6▒µm; n=74) were calculated. CONCLUSION Overhead mounted optical coherence tomography allowed high-quality image acquisition and analysis in childhood glaucoma patients unable to be imaged with the tabletop counterpart, presenting opportunity for improved clinical management and study of childhood glaucoma-related pathophysiology. Peripapillary retinal nerve fiber layer, parafoveal total retinal thickness, and parafoveal ganglion cell complex thickness were decreased for affected eyes of children <6 years old compared to age-matched controls from a companion normative study.