Reproducibility of and Effect of Magnification on Optical Coherence Tomography Measurements in Children

doi:10.1016/j.ajo.2006.11.042

American Journal of Ophthalmology

Volume 143, Issue 3, March 2007, Pages 484-488.e2

https://doi.org/10.1016/j.ajo.2006.11.042 Get rights and content

Purpose

To determine the reproducibility of optical coherence tomography (OCT) measurements of macular thickness, peripapillary nerve fiber layer (NFL) thickness, and optic disk parameters and to investigate the effect of axial length and refractive error on these measurements in children with healthy eyes.

Design

Cross-sectional study.

Methods

The Sydney Childhood Eye Study examined 2,353 year 7 students (75.3% response) from a random cluster sample of 21 secondary schools across Sydney. A consecutive subsample of 120 children had OCT (StratusOCT, Carl Zeiss, Dublin, California, USA) performed by a single operator, which was repeated with a brief rest between the two sessions. Scans of the NFL, macula, and optic disk were performed.

Results

Intersubject variability of measurements of macular thickness, NFL thickness, and optic disk parameters assessed using intraclass correlation coefficients accounted for >85%, >62%, and >38% of total variability of measurements, respectively. Corresponding coefficients of variability were <5%, <8%, and <13%. Magnification effects attributable to axial length and refractive error on the measurement of these parameters were statistically not significant.

Conclusion

The StratusOCT demonstrated reproducible measurements of macular and NFL thickness. Measurement of most optic disk parameters were also reproducible. Magnification attributable to axial length and refractive error had minimal impact on measurements of macular and NFL thickness.

Section snippets

Study sample

The Sydney Myopia Study is a population-based survey of eye health in school children residing in the Sydney metropolitan area. The study was approved by the Human Research Ethics Committee, University of Sydney, and the Department of Education and Training, New South Wales, Australia. The study adhered to the tenets of the Declaration of Helsinki. We obtained informed written consent from at least one parent, as well as verbal consent from each child. This project forms part of the Sydney

Results

The mean (standard deviation) age, refractive error, and axial length of children in this study were 13.3 (0.3) years, −0.06 (2.01) D, and 23.36 (1.12) mm, respectively; 86.7% of the children were of Caucasian background, with the remainder of Middle Eastern and South East Asian background. Only data for right eyes are reported, as there was high correlation (r > 0.86) of measurements between right and left eyes.

Discussion

A critical test for any instrument is its measurement reproducibility, which refers to the consistency of measurements repeated over time. It can be described by assessing several parameters, including the CoV, the ICC, and the absolute difference between repeated measurements. High measurement reproducibility is a prerequisite for quantitative application of OCT in research and clinical work.

In our study, macular thickness measurements were most reproducible at the central macula (central 1

Paul Mitchell, MD, PhD, FRANZCO, is a medical retina specialist in Sydney with major clinical interests in ocular epidemiology. He is Principal Investigator of the Blue Mountains Eye Study and a 10-year Australian population-based study of age-related eye disease. Dr Mitchell is Principal Investigator of the Sydney Childhood Eye Study (incorporating the Sydney Myopia Study), which examined eye health in 1,740 6-year old and 2,353 12-year old children. An ongoing study will assess a further

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Cited by (72)

Role of optical coherence tomography in unilateral amblyopia
2023, Journal Francais d'Ophtalmologie
Comparer les paramètres maculaires et papillaires évalués grâce à la tomographie en cohérence optique (OCT), entre l’œil amblyope et l’œil sain, chez des sujets ayant une amblyopie unilatérale anisométrique ou strabique.
Il s’agit d’une étude transversale et comparative effectuée sur une période de deux ans, allant du 1^er avril 2019 au 31 mars 2021. Nous avons inclus des patients âgés de plus de 5 ans, suivis pour amblyopie fonctionnelle unilatérale, indemnes de toute pathologie neurologique et/ou oculaire. L’évaluation des paramètres maculaires et papillaires, au niveau de l’œil amblyope et de l’œil sain, a été faite à la Tomographie en Cohérence Optique Swept Source (OCT-SS). Leur comparaison a été réalisée en fonction de la tranche d’âge et du type d’amblyopie.
Nous avons colligé 50 patients, 29 enfants et 21 adultes, ayant un âge moyen de 19,8 ans. L’amblyopie était secondaire à une anisométropie chez 40 patients, et à un strabisme chez 10 patients. L’analyse des paramètres tomographiques maculaires n’a pas trouvé de différence significative entre les yeux amblyopes et les yeux sains, pour l’épaisseur maculaire moyenne (p = 0,86), l’épaisseur maculaire centrale (p = 0,86), et le volume maculaire moyen (p = 0,54). L’épaisseur moyenne des fibres rétiniennes péripapillaires (RNFL) était de 107,48 μm au niveau de l’œil amblyope et de 103,8 μm à l’œil sain, avec une différence statiquement significative (p < 0,001). Cet épaississement significatif des RNFL des yeux amblyopes intéressait aussi bien les adultes (p < 0,001), et les enfants (p < 0,001), les anisométropes (p < 0,001), et les strabiques (p = 0,024). L’étude des autres paramètres de la tête du nerf optique n’a pas révélé de différence significative entre les yeux amblyopes et les yeux sains, à savoir la surface de disque optique (p = 0,89), la surface de l’anneau neuro-rétinien (p = 0,47) et le rapport cup sur disc vertical (p = 0,98) et horizontal (p = 0,74)
L’amblyopie s’accompagne d’un épaississement des fibres rétiniennes péri-papillaires, sans répercussion maculaire. Cependant, d’autres études prospectives plus larges s’avèrent nécessaires pour confirmer ces résultats.
To compare the macular and papillary parameters on optical coherence tomography (OCT) between the amblyopic eye and the healthy eye in subjects with unilateral strabismic or anisometropic amblyopia.
This is a cross-sectional and comparative study carried out over two years, from April 1, 2019, to March 31, 2021. We included patients aged over 5 years, followed for unilateral amblyopia, free of any neurological and/or ocular pathology. The evaluation of the macular and papillary parameters in the amblyopic and healthy eyes was performed with Swept-Source Optical Coherence Tomography (OCT-SS). The parameters were compared according to age group and type of amblyopia.
We collected 50 patients, 29 children, and 21 adults, with a mean age of 19.8 years. Amblyopia was secondary to anisometropia in 40 patients and strabismus in 10 patients. Analysis of macular tomographic parameters found no significant difference between amblyopic eyes and healthy eyes for mean macular thickness (P = 0.86), central macular thickness (P = 0.86), or mean macular volume (P = 0.54). The mean retinal peripapillary fiber thickness (RNFL) was 107.48 μm in the amblyopic eye and 103.8 μm in the healthy eye, with a statistically significant difference (P < 0.001). This significant thickening of the RNFL in amblyopic eyes was present in adults (P < 0.001), children (P < 0.001), anisometropic (P < 0.001), and strabismic amblyopia (P = 0.024). Analysis of the other optic nerve head parameters revealed no significant difference between amblyopic eyes and healthy eyes in terms of optic disc surface area (P = 0.89), neuro-retinal annulus surface area (P = 0.47), vertical (P = 0.98) or horizontal (P = 0.74) cup to disc ratio.
Amblyopia is accompanied by thickening of the peripapillary retinal fibers without macular repercussions. However, larger prospective studies are needed to confirm these results.
Bruch membrane opening-minimum rim width and retinal nerve fiber layer thickness in myopic children
2021, Photodiagnosis and Photodynamic Therapy
It is debatable whether the decrease of retinal nerve fiber layer (RNFL) thickness in myopic people under 18 years of age is due to insufficient measurement techniques or to real physical loss of retinal ganglion cells and axons. Hence, to better understand the relationship between the degree of myopia and the neuroretinal rim (NR), we aim to investigate the NR in the eyes of healthy myopic children using the novel measurement algorithms of spectral-domain optical coherence tomography (SD-OCT).
This prospective, cross-sectional study includes 378 left eyes of 378 (301 female) participants divided into three groups according to their spherical equivalent (SE) refractive error (RE) [Group-1(G1), -1.00 ≤ SE ≤ 1.00 diopters (D); Group-2 (G2), -4.00 ≤ SE < -1.00 D; Group-3 (G3), SE<-4.00 D]. All participants underwent a full ophthalmic examination, including biometric and pachymetric measurements. Standard peripapillary RNFL, as well as the novel algorithms, Bruch's membrane opening-minimum rim width (BMO-MRW), and RNFL acquired using the anatomic positioning system (APS-RNFL) were obtained by SD-OCT. Nasal, temporal, temporal-inferior, temporal-superior, nasal-inferior, nasal-superior sectors’ and their general (global) averages were recorded. Rim areas and disc sizes were measured via confocal scanning laser ophthalmoscopy. Global and the six sectors’ averages were recorded.
G1 consisted of 141 subjects, G2 consisted of 89, and G3 consisted of 48. The sex distribution (p = 0.112) and mean age (p = 0.129) of the groups were similar. The mean global averages of the standard RNFLs were 96 ± 14.4 µ in G1, 93.8 ± 12.9 µ in G2, and 86 ± 11.8 µ in G3. The mean global averages of the APS-RNFLs were 103.9 ± 97 µ in G1, 103.3 ± 10.6 µ in G2, and 102 ± 10.6 µ in G3. The mean global averages of the BMO-MRW were 374.4 ± 57.7 µ in G1, 373.2 ± 62.2 µ in G2, and 351.9 ± 63.9 µ in G3. For the global averages, APS-RNFL and BMO-MRW did not detect any difference between the three groups (p = 0.563, p = 0.089, respectively), but the standard RNFL did (p < 0.001). Standard RNFL and APS-RNFL were found to be well correlated; however, the correlations between BMO-MRW and standard RNFL or APS-RNFL were either absent or very weak. All three methods showed weak but significant negative correlations with high myopic spherical RE, especially those in the standard RNFL. Moderately negative correlations were found between BMO-MRW and disc size in all sectors (highest in the nasal sector; r = -0.387, p < 0.001). However, there was almost no significant relationship between disc size and standard RNFL or APS-RNFL. Moderately significant negative correlations were observed between the groups categorically and standard RNFL in almost all sectors, while this was much less with APS-RNFL and was not observed in almost any sector with BMO-MRW.
When evaluating the NR in healthy myopic children, it was found that, in particular, BMO-MRW and APS-RNFL are less effected by RE degree compared to standard RNFL. BMO-MRW and APS-RNFL should be used on these children to avoid the possible misdiagnosis of glaucoma.
Evaluation of Bruch's membrane opening-minimum rim width and retinal nerve fiber layer thickness in adults with anisometropic amblyopia
2020, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
Our present data is in agreement with these results. In contrast, Wu et al. reported significantly thicker RNFLT findings on amblyopia eyes compared to controls in children with a mean age of 9.7 years.24 Although some studies supported the effects of magnification attributed to the axial length and refractive error on the measurement of the RNFLT thickness, the effect was not clearly explained the influence on the difference in the RNFLT thickness yet [25,26]. thought that, differences in RNFLT on different studies might be attributed to the use of different algorithms and formulas accounting for axial length and refractive error.
To investigate the relationship between Bruch’s membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) in adult patients anisometropic amblyopia using spectral domain optical coherence tomography (SD−OCT).
In this cross-sectional, observational study, 43 anisometropic eyes with corresponding fellow eyes. BMO-MRW (shortest distance from BMO to the internal limiting membrane) and peripapillary RNFLT were obtained with Spectral Domain Optic Coherence Topography (SD−OCT). Global and six sectors values according to the legacy distribution of the SD−OCT (nasal [N], nasal superior [NS], temporal superior [TS], temporal [T], temporal inferior [TI], and nasal inferior [NI]) for both RNFLT and BMO-MRW were evaluated.
Mean RNFLT and BMO-MRW measurements comparison showed no significance between anisometropia and fellow eyes. In correlation analyses ; although all sectors showed significant positive correlations; the global, TS and NI BMO-MRW sectors were significantly correlated with their corresponding RNFLT within both anisometropia and fellow eyes. In subgroup caparison analyses RNFLT and BMO-MRW showed no differences between amblyopia and fellow eyes. On subgroups correlation analyses, there were not a consistent correlation sectors between RNFLT and BMO-MRW.
In the analysis of the BMO-MRW and RNFLT measurements obtained by SD−OCT in adult anisometropic amblyopia patients, both parameters were evaluated not significant on showing structural changes. In correlation analysis within amblyopic and fellow eye groups, while there was positive correlation on all sectors, statistically significant relationships were detected in global, NI, TS sectors for both BMO-MRW and RNFLT measurements.
Nerve fiber layer and retinal ganglion cells layer thickness using optical coherence tomography in a healthy Mexican population under eighteen
2017, Revista Mexicana de Oftalmologia
Describir el valor promedio y la desviación estándar del grosor de la capa de fibras nerviosas y células ganglionares de la retina medidos por tomografía de coherencia óptica en población mexicana menor de 18 años.
Estudio observacional, descriptivo, prospectivo, trasversal. Niños que acuden al servicio de oftalmología del centro de Investigación y Docencia en Ciencias de la Salud-Hospital Civil de Culiacán, de octubre de 2014 a diciembre de 2015.
La mínima de grosor de capa de fibras nerviosas fue de 90 μm y el máximo de 152 μm con una media de 112.5 ± 9.9 μm. El mínimo grosor del complejo de células ganglionares fue de 82 μm, un máximo de 111 μm, con una media de 96.3 ± 5 μm.
La tomografía de coherencia óptica puede ser aplicada en nuestra población, en pacientes menores de 18 años sospechosos de glaucoma, basándonos en los resultados obtenidos en el presente estudio.
To describe the mean value and standard deviation of the thickness of the nerve fiber layer and retinal ganglion cell measured by optical coherence tomography in Mexican population less than 18 years old.
Observational, descriptive, prospective, cross-sectional study. Children attending in the ophthalmology department of Centro de Investigación y Docencia en Ciencias de la Salud-Hospital Civil de Culiacán from October 2014 to December 2015.
The minimum thickness of the nerve fiber layer was 90 μm and a maximum of 152 μm with a mean of 112.5 ± 9.9 μm. The minimum thickness of the ganglion cell complex was 82 μm, a maximum of 111 μm, with a mean of 96.3 ± 5 μm.
The optical coherence tomography can be applied in our population, in patients under 18 glaucoma suspects, and both RNFL thickness as the GCC are reliable for the assessment and reference can be taken from those obtained in this study.
Optic Nerve Head Development in Healthy Infants and Children Using Handheld Spectral-Domain Optical Coherence Tomography
2016, Ophthalmology
Citation Excerpt :
We report excellent interexaminer reproducibility of ONH parameters (Table 2), with ICC reported of more than 0.83 for diametric measures of all participants, including those younger than 4 years. These were comparable with the results from studies of older children imaged with table-mounted OCT systems.11,32,33 In a study of 100 children older than 6 years, Altemir et al11 report ICCs between 0.773 and 0.96 for RNFL, disc area, and rim area using Cirrus automated optic nerve analysis software.
To determine feasibility of optic nerve head (ONH) imaging and to characterize ONH development in full-term infants without sedation using handheld spectral-domain optical coherence tomography (SD OCT).
Prospective cross-sectional study.
Three hundred fifty-two children aged between 1 day and 13 years.
All participants were imaged using handheld SD OCT without sedation during a single scan session. The percentage of successful scans was calculated. Interexaminer reproducibility and differences between right and left eyes were assessed using intraclass correlation coefficients (ICCs). Images were analyzed using ImageJ software. The developmental trajectories over time for ONH parameters were calculated using fractional polynomial modelling.
Disc and cup diameter (expressed as distance in micrometers and visual angle in degrees), cup depth, Bruch's membrane opening–minimum rim width (BMO-MRW), retinal thickness, and retinal nerve fiber layer (RNFL; 1700 μm and 6° from the disc center).
On average, 70% of participants were imaged successfully. Interexaminer reliability was excellent (ICC, >0.89) for diametric and retinal thickness parameters. Right and left eyes were similar for diametric measurements (ICC, >0.79), but more variable for nasal BMO-MRW, RNFL, and retinal thickness. The mean disc and cup diameter increase by 30% and 40%, respectively, between birth and 13 years of age when expressed as a distance measure, but remained constant (at 5°–5.5° and 2°, respectively) when expressed as a visual angle with reference to the eye nodal point. The peripapillary temporal RNFL demonstrated a marked initial decrease of nearly 35% between birth and approximately 18 months of age. This was followed by a slow increase up to 12 years of age when measured at 1700 μm from the disc center, although there was little change when measured at 6° from the disc center.
We demonstrated feasibility of handheld SD OCT imaging of the ONH in full-term infants and children without anaesthesia or sedation. This is the first in vivo handheld SD OCT study to describe the development of ONH parameters during the critical early years of visual maturation. Our results provide a normative database for use in routine practice and further studies of ONH pathologic features.
Effect of Ocular Magnification on Macular Choroidal Thickness Measurements Made Using Optical Coherence Tomography in Children
2022, Current Eye Research

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Xiu Ying Wang, MB, MMed (Ophth), is a qualified Ophthalmologist from People’s Republic of China, finishing her Master Degree in China and now pursuing her PhD at the University of New South Wales, Sydney, Australia. Dr Wang is a receipt of Australian Asian Award.

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Original articleReproducibility of and Effect of Magnification on Optical Coherence Tomography Measurements in Children

Purpose

Design

Methods

Results

Conclusion

Section snippets

Study sample

Results

Discussion

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Reproducibility of retinal thickness measurements in normal eyes using optical coherence tomography

Ophthalmic Surg Lasers

Reproducibility of nerve fiber thickness, macular thickness, and optic nerve head measurements using StratusOCT

Invest Ophthalmol Vis Sci

Reproducibility of retinal mapping using optical coherence tomography

Arch Ophthalmol

Repeatability and reproducibility of macular thickness measurements with the Humphrey OCT system

Invest Ophthalmol Vis Sci

Original article
Reproducibility of and Effect of Magnification on Optical Coherence Tomography Measurements in Children