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Biphasic change in retinal nerve fibre layer thickness from 30 to 60 weeks postmenstrual age in preterm infants
  1. Liangbo L. Shen1,
  2. Shwetha Mangalesh2,
  3. Brendan McGeehan3,
  4. Kai R. Seely2,
  5. Vincent Tai2,
  6. Neeru Sarin2,
  7. Joanne Finkle4,
  8. Katrina P. Winter2,
  9. Du Tran-Viet2,
  10. Sharon F. Freedman2,
  11. Mays A. El-Dairi2,
  12. Gui-Shuang Ying3,
  13. Cynthia A. Toth2,5
  1. 1 Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
  2. 2 Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
  3. 3 Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4 Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
  5. 5 Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Cynthia A. Toth, Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27708, USA; Cynthia.toth{at}


Background/Aims The optic nerve development during the critical postnatal weeks of preterm infants is unclear. We aimed to investigate the change of retinal nerve fibre layer (RNFL) in preterm infants.

Methods We used an investigational handheld optical coherence tomography (OCT) system to serially image awake preterm infants between 30 and 60 weeks postmenstrual age (PMA) at the bedside. We assessed RNFL thickness in the papillomacular bundle and nasal macular ganglion cell layer+inner plexiform layer (GCL+IPL) thickness. We applied a segmented mixed model to analyse the change in the thickness of RNFL and GCL+IPL as a function of PMA.

Results From 631 OCT imaging sessions of 101 infants (201 eyes), RNFL thickness followed a biphasic model between 30 and 60 weeks, with an estimated transition at 37.8 weeks PMA (95% CI: 37.0 to 38.6). RNFL thickness increased at 1.8 μm/week (95% CI: 1.6 to 2.1) before 37.8 weeks and decreased at −0.3 μm/week (95% CI: −0.5 to −0.2) afterwards. GCL+IPL thickness followed a similar biphasic model, in which the thickness increased at 2.9 μm/week (95% CI: 2.5 to 3.2) before 39.5 weeks PMA (95% CI: 38.8 to 40.1) and then decreased at −0.8 μm/week (95% CI: −0.9 to −0.6).

Conclusion We demonstrate the feasibility of monitoring RNFL and GCL+IPL thickness from OCT during the postnatal weeks of preterm infants. Thicknesses follow a biphasic model with a transition age at 37.8 and 39.5 weeks PMA, respectively. These findings may shed light on optic nerve development in preterm infants and assist future study designs.

  • optic nerve
  • imaging
  • retina
  • child health (paediatrics)

Data availability statement

Data are available on reasonable request. Data are available on reasonable request to the corresponding author.

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Data availability statement

Data are available on reasonable request. Data are available on reasonable request to the corresponding author.

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  • Contributors Conception and design: LLS, SM, BMG, SFF, MAE, G-SY, CT. Data collection: SM, BMG, VT, NS, JF, KPW, DT-V. Data analysis: LLS, BMG. Data interpretation, LLS, SM, BMG, KRS, SFF, MAE, G-SY, CT. Obtained funding: G-SY, CT. Manuscript writing: LLS, SM, BMG, KRS, VT, NS, JF, KPW, DT-V, SFF, MAE, G-SY, CT. Overall content as guarantor: CT.

  • Funding The study was supported by grants RO1 EY025009 and P30 EY005722 from the National Eye Institute (NEI). This publication was made possible by the James G. Hirsch Endowed Medical Student Research Fellowship from Yale School of Medicine.

  • Disclaimer The contents are solely the responsibility of the authors and do not necessarily represent the official view of NEI or NIH. The sponsors or funding organisations had no role in the design or conduct of this research.

  • Competing interests SFF: Qlaris—consultant; CT: Alcon Laboratories—royalties; EMMES—consultant; Theia Imaging—owner equity and consultant.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.