OPTIC DISC-RNFL IN PEDIATRIC POPULATION

Optic disc and retinal nerve fiber layer (RNFL) measurements by optical coherence tomography (OCT) are important investigations in detecting glaucoma. However, the results of the OCT measurements are influenced by a normative database with which the measurements are compared. 

The results of the OCT findings in adults are reliable because of the large and stable database. However, in children below 18 years of age, the database is usually not robust, and so the OCT results are not clear.

There have been a few studies of OCT in children, and the results of those studies are being presented here.

Adem et al. reported the average peri-papillary RNFL thickness in children between 6 to 16 years of age was 106.45 9.41 μm; the average macular thickness was 326.44 14.17 μm; and the average macular volume was 0.257 0.011 mm³. The aforementioned OCT measurements were not significantly correlated with age, SE, or AL values (P > .05 for all). [Turk A, Ceylan OM, Arici C, Keskin S, Erdurman C, Durukan AH, Mutlu FM, Altinsoy HI. Evaluation of the nerve fiber layer and macula in the eyes of healthy children using spectral-domain optical coherence tomography. Am J Ophthalmol. 2012 Mar;153(3):552-559.e1.]

Patel et al. have reported the average retinal nerve fiber layer (RNFL) thickness measured with spectral-domain (SD) OCT in children between 5 and 18 years of age to be 102 to 113μm. [Patel A, Purohit R, Lee H, Sheth V, Maconachie G, Papageorgiou E, McLean RJ, Gottlob I, Proudlock FA. Optic Nerve Head Development in Healthy Infants and Children Using Handheld Spectral-Domain Optical Coherence Tomography. Ophthalmology. 2016 Oct;123(10):2147-57.] Susan et al. found the mean peripapillary RNFL thickness in children aged 5 to 15 years to be 107.6 ± 1.2 μm. [Yanni SE, Wang J, Cheng CS, Locke KI, Wen Y, Birch DG, Birch EE. Normative reference ranges for the retinal nerve fiber layer, macula, and retinal layer thicknesses in children. Am J Ophthalmol. 2013 Feb;155(2):354-360.e1.] In a study by Raffa regarding the normative OCT reference ranges in healthy Saudi children, the mean values for RNFL thickness, disc area, rim area, and cup volume were 93.9 μm, 2 mm², 1.6 mm², and 0.3 mm³, respectively. The vertical ratio of cup to disc was 0.4. [Raffa L, AlSwealh SS. Normative optical coherence tomography reference ranges of the optic nerve head, nerve fiber layer, and macula in healthy Saudi children. Saudi Med J. 2023 Nov 28;44(12):1269-1276.] An OCT study of 113 healthy children aged 6 to 17 years with no ocular abnormality except refractive error showed the mean RNFL thickness was 95.6+/-8.7 μm. [Al-Haddad C, Barikian A, Jaroudi M, Massoud V, Tamim H, Noureddin B. Spectral domain optical coherence tomography in children: normative data and biometric correlations. BMC Ophthalmol. 2014 Apr 22;14:53.] A multi-center Spanish study in normal children reported the following data: The mean global RNFL thickness was 97.40 ± 9.0 μm (range, 77-121.7 μm). [Barrio-Barrio J, Noval S, Galdós M, Ruiz-Canela M, Bonet E, Capote M, Lopez M. Multicenter Spanish study of spectral-domain optical coherence tomography in normal children. Acta Ophthalmol. 2013 Feb;91(1):e56-63.]

This study is by Hassan et al. from Iran, 9051 eyes of 4784 children were analyzed.

Vertical cup-to-disc ratio	0.45±0.15(0.45–0.46) mm
Average cup-to-disc ratio	0.43±0.14 (0.42–0.43) mm
Rim area	1.46±0.25 (1.45–1.47) mm2
Disc area	1.92±0.35 (1.91–1.93) mm2
Cup volume	0.14±0.14 (0.14–0.15) mm3

The mean±SD and 95% confidence intervals (in parentheses)

Hashemi, Hassan; Khabazkhoob, Mehdi; Heydarian, Samira; Emamian, Mohammad Hassan; Fotouhi, Akbar. Optic Disc Measurements in Children by Optical Coherence Tomography. Journal of Glaucoma 32(5):p 361-368, May 2023.