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Evaluation of optic nerve development in preterm and term infants using handheld spectral-domain optical coherence
Amy Y Tong1, Mays El-Dairi2, Ramiro S Maldonado1
1Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
Insights
Premature infants show larger optic nerve cup diameter and cup-to-disc ratio by term-equivalent age. These optic nerve parameters weakly correlate with central nervous system pathology and cognitive development in preterm infants.
Area of Science:
- Ophthalmology
- Neonatology
- Neuroscience
Background:
- Premature birth can impact neurodevelopment.
- Early identification of central nervous system (CNS) pathology is crucial.
- Optic nerve (ON) parameters may serve as potential indicators of CNS development.
Purpose of the Study:
- To evaluate the effects of prematurity on early optic nerve (ON) development.
- To assess the utility of ON parameters as indicators of CNS development and pathology in preterm infants.
Main Methods:
- Prospective, cross-sectional, and longitudinal study design.
- Analysis of optic nerve (ON) images from portable handheld spectral-domain optical coherence tomography (SD-OCT) in 44 preterm and 52 term infants.
- Quantitative analysis of vertical cup diameter (vCD), vertical disc diameter (vDD), and vertical cup-to-disc ratio (vCDR), correlated with neurodevelopmental and CNS pathology indicators.
Main Results:
- At 37-42 weeks postmenstrual age (PMA), preterm infants exhibited significantly larger vCD and vCDR compared to term infants.
- Longitudinal analysis revealed significant changes in vDD and vCDR in preterm infants.
- Larger vCD and vCDR were associated with periventricular leukomalacia; shallower cup with posthemorrhagic hydrocephalus; and larger vCDR with clinical magnetic resonance imaging findings and lower cognitive scores.
Conclusions:
- This study is the first to analyze ON parameters in premature infants using SD-OCT.
- Preterm infants demonstrate larger vCD and vCDR by term-equivalent age.
- Optic nerve parameters show a weak association with CNS pathology and cognitive development, warranting further investigation with larger cohorts.
Purpose:
To evaluate effects of prematurity on early optic nerve (ON) development and the usefulness of ON parameters as indicators of central nervous system (CNS) development and pathology.
Design:
Prospective, cross-sectional, longitudinal study.
Participants:
Forty-four preterm infants undergoing retinopathy of prematurity (ROP) screening and 52 term infants.
Methods:
We analyzed ON from portable handheld spectral-domain optical coherence tomography (SD-OCT) images (Bioptigen, Inc, Research Triangle Park, NC) of 44 preterm and 52 term infants. The highest-quality ON scan from either eye was selected for quantitative analysis. Longitudinal analysis was performed at 31-36 weeks and 37-42 weeks postmenstrual age (PMA). Preterm ON parameters also were assessed for correlation with indicators of cognitive, language, and motor development and CNS pathology.
Main Outcome Measures:
Vertical cup diameter (vCD), vertical disc diameter (vDD), vertical cup-to-disc ratio (vCDR), cup depth, and indicators of neurocognitive development and CNS pathology.
Results:
At 37-42 weeks PMA, preterm infants had larger vCD and vCDR than term infants (908 vs. 700 μm [P<0.001] and 0.68 vs. 0.53 μm [P<0.001], respectively), whereas cup depth and vDD were not significantly different. Longitudinal changes (n = 26 preterm eyes; mean interval, 4.7 weeks) in vDD and in vCDR were an increase of 74 μm (P = 0.008) and decrease of 0.05 (P = 0.015), respectively. In preterm infants (n = 44), periventricular leukomalacia was associated with larger vCD (1084 vs. 828 μm; P = 0.005) and vCDR (0.85 vs. 0.63; P<0.001), posthemorrhagic hydrocephalus was associated with shallower cup (331 vs. 456 μm; P = 0.030), and clinical magnetic resonance imaging was associated with larger vCDR (0.73 vs. 0.64; P = 0.023). In 23 preterm infants with Bayley Scales of Infant Development scores, larger vCDR was associated with lower cognitive scores (P = 0.049).
Conclusions:
This is the first analysis of ON parameters in premature infants using SD-OCT. It demonstrated that by age of term birth, vCD and vCDR are larger in preterm infants who were screened for ROP than in term infants. In this prospective pilot study, ON parameters in these preterm infants associate weakly with CNS pathology and future cognitive development. Future prospective studies with larger numbers are necessary before further conclusions can be made.
