Using Optical Coherence Tomography in Pediatric Neuro-ophthalmology

Area of Science:

• Pediatric Neuro-ophthalmology
• Ophthalmology Imaging
• Medical Technology Integration

Background:

• Optical coherence tomography (OCT) is established in adult neuro-ophthalmology but underutilized in pediatrics.
• Perceived barriers include technical, financial, and practical challenges to pediatric OCT adoption.

Purpose of the Study:

• To provide a pragmatic framework for integrating OCT into pediatric neuro-ophthalmology clinics.
• To guide clinicians in obtaining reliable OCT images in awake children and interpreting findings.

Main Methods:

• Review of technical aspects of tabletop and handheld OCT in children (positioning, fixation).
• Outline of key clinical OCT modalities (single-line scans, cube maps) and interpretation strategies.
• Structured approach combining RNFL and GCL measurements for differential diagnosis.

Main Results:

• Demonstrates OCT's utility in diagnosing conditions like papilledema, optic neuritis, and optic atrophy in children.
• Highlights strategies for accurate interpretation, including correcting for axial length and identifying segmentation errors.
• Shows how OCT can narrow differential diagnoses and guide urgent workups for decreased vision.

Conclusions:

• OCT can be a routine, child-friendly extension of the pediatric neuro-ophthalmic examination.
• Practical guidance facilitates overcoming barriers to pediatric OCT implementation.
• OCT enhances diagnostic capabilities for various pediatric optic nerve and retinal conditions.