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Optic disc parameters and associations with early life exposures in over 3000 12-year-old children: findings from the
Alexandra L Creavin1, Kate Tilling2, Nicholas Timpson3
1Clinical Lecturer, Bristol Medical School, University of Bristol, Bristol, UK. Alexandra.creavin@bristol.ac.uk.
Insights
Small optic discs and large cup-to-disc ratios are common in 12-year-olds, with increased odds linked to severe prematurity, low BMI, maternal smoking, and small head circumference. Optimizing risk factors may improve lifelong ocular health.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- Optic disc size and cup-to-disc ratio are key indicators of ocular health.
- Prevalence data in pediatric populations are essential for understanding risk factors and long-term outcomes.
- Associations between maternal and early-life factors and optic disc parameters require further investigation.
Purpose of the Study:
- To determine the distribution of small optic discs and large cup-to-disc ratios in a pediatric cohort.
- To explore associations between these optic disc parameters and maternal/environmental factors.
- To identify potential risk factors influencing ophthalmic neurodevelopment.
Main Methods:
- Retinal photographs from over 3000 12-year-olds in the Avon Longitudinal Study of Parents and Children were analyzed.
- Cup-to-disc area ratio (CDAR) and cup-to-fovea/disc diameter (CF/DD) were graded.
- Regression models were used to examine associations with maternal and early-life exposures.
Main Results:
- 11% of children had a CDAR > 0.3, with significantly increased odds in underweight (aOR 2.9) and severely premature (aOR 28) children.
- 6% of children had small discs (CF/DD > 3), with increased odds associated with maternal smoking (aOR 1.7) and small head circumference (aOR 2.5).
- Severe prematurity (<28 weeks) was strongly associated with a large cup-to-disc ratio.
Conclusions:
- Small optic discs and large cup-to-disc ratios are more prevalent in 12-year-olds than previously thought.
- Severe prematurity, low child BMI, maternal smoking, and small head circumference are significant risk factors.
- Optimizing pregnancy, delivery, and early childhood nutrition may positively impact ophthalmic neurodevelopment and lifelong ocular health.
Objectives:
We aimed to investigate the distribution of small optic discs and large cup-to-disc ratio in children and to examine associations with maternal and environmental factors.
Methods:
Retinal photographs were graded from over 3000 12-year-olds in the Avon Longitudinal Study of Parents and Children. Regression models examined associations between disc parameters and maternal and early-life exposures.
Results:
Mean cup-to-disc area ratio (CDAR) for 3288 children was 0.21 (95%CI 0.20,0.21). Discs with CDAR > 0.3 were present in 11%. The odds of CDAR > 0.3 were increased nearly three-fold in underweight children (adjusted odds ratio (aOR) 2.9 (1.1, 7.3) p = 0.03) and 28-fold in severely premature ( < 28 weeks) children (paOR 28 95%CI 4.6,172, p < 0.001) with nearly one in four children affected. Mean cup-to-fovea/disc diameter (CF/DD) for 3327 children was 2.48 (95%CI 2.47,2.50). Small discs (CF/DD > 3) were present in 6% of which a third were bilateral. The odds of a small disc were increased in the offspring of mothers who smoked in pregnancy (aOR 1.7 (1.0,2.8) p = 0.04) and more than doubled in children born with a small head circumference (aOR 2.5 (1.4,4.5) p < 0.001).
Conclusions:
Small optic discs and high cup-to-disc ratio are more frequent than usually supposed at age 12. The odds of CDAR > 0.3 are increased by severe prematurity and pathologically low child BMI. The odds of a small disc are increased by maternal smoking and small head circumference. Optimisation of risk factors in pregnancy and delivery and early childhood nutrition may play an important role in ophthalmic neurodevelopment and thus have a lifelong impact on ocular health.
