AS-OCT in Childhood Glaucoma

 

Anterior segment optical coherence topography (AS-OCT) is a non-contact imaging modality that uses low-coherence interferometry to visualize the ocular anterior segment structures.

AS-OCT has demonstrated its ability in adults to accurately measure corneal thickness, epithelial thickness, angle opening distance (AOD), angle recess area (ARA), anterior chamber depth (ACD), and lens vault.

Hand-held OCT (HH-OCT) has emerged as a valuable tool in the diagnosis and management of various pediatric optic neuropathies.

A comprehensive literature search was performed in October 2024 across four major databases: PubMed, Web of Science, EBSCOhost, and Google Scholar.The objective was to identify original studies evaluating the clinical application of AS-OCT—including HH-AS-OCT—in the assessment of childhood glaucoma.

15 studies including 406 glaucomatous eyes with diverse etiologies such as primary congenital, juvenile open-angle, post-cataract, and syndromic glaucoma published between 2012 and 2025 were included in the review.

AS-OCT enabled high-resolution visualization of the trabecular meshwork, Schlemm canal, iris, and anterior chamber angle. Several studies proposed diagnostic thresholds for iris thickness and angle width, with area under the receiver operating characteristic curves ranging from 0.69 to 0.87. Postoperative imaging documented drainage device position and angle anatomy, while HH-AS-OCT facilitated imaging in infants and uncooperative children, revealing subclinical abnormalities undetectable by gonioscopy; however, these structural findings do not consistently predict clinical outcomes. Heterogeneity in devices, imaging protocols, and glaucoma phenotypes limits standardization, and no definitive AS-OCT biomarker has yet emerged in childhood glaucoma. 

REFERENCE:

Abdelaal A, Kawji A, Gad W, Alzein A, Chang TC, Bitrian E, El Sayed YM, Gawdat GI, Hassan AK, El-Fayoumi D, Elhusseiny AM. Utilization of anterior segment optical coherence tomography in childhood glaucoma: A systematic review. Surv Ophthalmol. 2026 Jun 27:S0039-6257(26)00086-X. doi: 10.1016/j.survophthal.2026.06.011. Epub ahead of print. PMID: 42364735.