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Feasibility and Repeatability of Handheld Optical Coherence Tomography in Children With Craniosynostosis
Sohaib R Rufai1,2,3,4, Richard Bowman1,2, Catey Bunce5
1Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Insights
Handheld optical coherence tomography (OCT) is feasible and repeatable for assessing children with craniosynostosis. This technology aids in the clinical surveillance of optic nerve head parameters in these patients.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Medical Imaging
Background:
- Craniosynostosis, a premature fusion of skull sutures, can lead to increased intracranial pressure and visual complications.
- Accurate and repeatable assessment of the optic nerve head (ONH) is crucial for managing children with craniosynostosis.
- Traditional fundoscopy may not always detect subtle ONH changes indicative of intracranial hypertension.
Purpose of the Study:
- To evaluate the feasibility and repeatability of handheld optical coherence tomography (OCT) in pediatric patients diagnosed with craniosynostosis.
- To assess the utility of handheld OCT for ONH parameter measurement in this specific population.
Main Methods:
- A prospective cross-sectional study involving 50 children (0-18 years) with syndromic and non-syndromic craniosynostosis.
- Handheld OCT was used to image the optic nerve head (ONH).
- Feasibility was determined by recruitment and imaging success rates; repeatability was assessed using intraclass correlation coefficients (ICCs) on repeated ONH scans.
Main Results:
- Successful recruitment of all 50 children (100%) and successful ONH imaging in 86% of cases.
- Good repeatability was demonstrated for ONH parameters (ICC range, 0.77-0.99), with most exceeding 0.90.
- Handheld OCT identified two cases of intracranial hypertension, one missed by fundoscopy.
Conclusions:
- Handheld OCT is a feasible and repeatable imaging modality for children with craniosynostosis.
- This technique offers a valuable tool for the clinical surveillance of ONH in pediatric craniosynostosis patients.
Purpose:
To determine whether handheld optical coherence tomography (OCT) is feasible and repeatable in children with craniosynostosis.
Methods:
This was a prospective cross-sectional study. Children with syndromic and non-syndromic craniosynostosis 0 to 18 years of age were recruited between February 13, 2020, and October 1, 2020. Main outcome measures included feasibility (patient recruitment and handheld OCT success rates) and repeatability, which were assessed using intraclass correlation coefficients (ICCs) where repeated images of the optic nerve head (ONH) within the same visit were available. ONH parameters used for repeatability analysis included cup depth, width, and area; disc width; rim height; retinal thickness; retinal nerve fiber layer thickness; and Bruch's membrane opening minimum rim width.
Results:
Fifty children were approached, and all 50 (100%) were successfully recruited. Median age was 51.1 months (range, 1.9-156.9; interquartile range, 37.0-74.2), and 33 of the children (66%) were male. At least one ONH image was obtained in 43 children (86%), and bilateral ONH imaging was successful in 38 children (76%). Factors boosting the likelihood of success included good understanding and cooperation of the child and parent/guardian and availability of an assistant. Repeatability analysis was performed in 20 children, demonstrating good repeatability (ICC range, 0.77-0.99; the majority exceeded 0.90). OCT correctly identified two cases of intracranial hypertension, one of which was undetected by prior fundoscopy.
Conclusions:
Handheld OCT is feasible and repeatable in children with syndromic and non-syndromic forms of craniosynostosis.
Translational Relevance:
Our handheld OCT approach could be used for the clinical surveillance of children with craniosynostosis.
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