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Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a
Sohaib R Rufai1,2,3, Noor Ul Owase Jeelani3,4, Richard Bowman5,3
1Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK Sohaib.Rufai@nhs.net.
Insights
Handheld optical coherence tomography (OCT) offers a non-invasive method to detect paediatric intracranial hypertension (IH). This study assesses its diagnostic accuracy, providing a safer alternative to invasive intracranial pressure (ICP) monitoring in children.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Medical Imaging
Background:
- Paediatric intracranial hypertension (IH) is a serious condition affecting children's brain and vision.
- Direct intracranial pressure (ICP) measurement is invasive, risky, and impractical for routine monitoring.
- Non-invasive methods are needed for accurate IH detection in at-risk children.
Purpose of the Study:
- To evaluate the diagnostic accuracy of handheld optical coherence tomography (OCT) for detecting IH in children.
- To compare handheld OCT findings with direct ICP measurements.
- To explore OCT as a non-invasive tool for managing paediatric IH.
Main Methods:
- Prospective study assessing handheld OCT diagnostic accuracy in children (0-18 years) at risk of IH.
- Inclusion criteria: craniosynostosis, idiopathic IH, space-occupying lesions, etc.
- Primary outcomes: handheld OCT vs. 48-hour ICP assessment for sensitivity, specificity, PPV, NPV, and accuracy.
Main Results:
- Diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV, accuracy) of handheld OCT for IH detection will be determined.
- Secondary outcome measures include visual acuity, fundoscopic exam, contrast sensitivity, visual field testing, and VEPs.
Conclusions:
- Handheld OCT shows potential as a non-invasive diagnostic tool for paediatric IH.
- This method could improve early detection and management of IH in children.
- Findings will be disseminated via publications, presentations, and media.
Introduction:
Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children.
Methods And Analysis:
This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible.
Ethics And Dissemination:
Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media.
Trial Registration Number:
ISRCTN52858719.
