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Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS) in Children: The Copenhagen Child Cohort 2000 Eye
Christopher Maximilian Behrens1, Lasse Malmqvist1, Morten Jørgensen1
1Department of Ophthalmology, Rigshospitalet(C.M.B., L.M., M.J., M.L., S.H.), Glostrup, Denmark.
Insights
Peripapillary hyperreflective ovoid mass-like structures (PHOMS) were found in 8.9% of children and are associated with myopia and tilted optic nerves. These findings suggest PHOMS are common and not necessarily indicative of optic neuropathy.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Optic Nerve Imaging
Background:
- Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are observed in optical coherence tomography (OCT) scans.
- Their prevalence and clinical significance in pediatric populations require further investigation.
Purpose of the Study:
- To determine the prevalence of PHOMS in a population-based cohort of children.
- To investigate the association of PHOMS with optic nerve head features and myopia.
Main Methods:
- An observational, population-based cohort study included 1407 children aged 11-12 years.
- OCT scans of optic nerve heads were analyzed for PHOMS, disc tilt, and prelaminar hyperreflective lines.
- Exclusion criteria included optic disc drusen or edema.
Main Results:
- PHOMS were present in 8.9% of children, predominantly in the superonasal quadrant.
- Children with PHOMS showed a higher prevalence of myopia (P < .001) and optic nerve head tilt (P < .001).
- Prelaminar hyperreflective lines were more common in children with PHOMS (17.9%) compared to those without (7.3%, P < .001).
Conclusions:
- PHOMS are prevalent in healthy children and associated with myopia and optic nerve head tilt.
- The presence of PHOMS should be interpreted cautiously and not automatically considered evidence of optic neuropathy.
- Prelaminar hyperreflective lines, associated with PHOMS, were linked to shorter axial length and certain prenatal factors.
Purpose:
To determine the prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in a population-based child cohort and to study their association with other optic nerve head features and myopia.
Design:
Observational, population-based cohort study of 1407 children aged 11-12 years.
Methods:
Optical coherence tomography scans of optic nerve heads were graded for PHOMS, disc tilt, prelaminar hyperreflective lines, and scleral canal diameter and investigated for associated prenatal and ocular parameters. Children with optic disc drusen or optic disc edema were excluded.
Results:
PHOMS were found in 8.9% of children. The location of PHOMS was predominantly in the superonasal section of the optic disc. Myopia and optic nerve head tilt were more common in children with PHOMS than in children without PHOMS (P < .001 and P < .001, respectively). Prelaminar hyperreflective lines were found in 17.9% of children with PHOMS compared to 7.3% of children without PHOMS (P < .001). Prelaminar hyperreflective lines with and without PHOMS were associated with a shorter axial length of the eye (P < .001). There were no prenatal factors associated with PHOMS. Prelaminar hyperreflective lines were associated with higher birth weight and continued maternal smoking during pregnancy (P = .01 and P = .02, respectively).
Conclusions:
PHOMS had a prevalence of 8.9% in healthy children without optic disc drusen or optic disc edema and was associated with increasing myopic refraction and the presence of a tilted optic nerve head and prelaminar hyperreflective lines. Given the high prevalence of PHOMS, they should not unreservedly be taken as evidence of optic neuropathy.
