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Quantitative and qualitative assessment of anterior segment optical coherence tomography capture of disease state in childhood anterior uveitis
  1. Katie Etherton1,
  2. Jugnoo S Rahi2,
  3. Harry Petrushkin3,4,
  4. Andrew D Dick5,
  5. Saira Akbarali4,
  6. Reshma Pattani4,
  7. Scott Hau6,
  8. Sandrine Lacassagne4,
  9. Xiaoxuan Liu7,
  10. Alastair K Denniston8,
  11. Ameenat Lola Solebo2
  1. 1Optometry Department, Moorfields Eye Hospital NHS Trust, London, UK
  2. 2Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
  3. 3Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  4. 4Rheumatology, Great Ormond Street Hospital for Children, London, UK
  5. 5NIHR Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, UK
  6. 6External Disease, Moorfields Eye Hospital, London, UK
  7. 7Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  8. 8Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
  1. Correspondence to Dr Ameenat Lola Solebo, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK; a.solebo{at}ucl.ac.uk

Abstract

Background/aims Anterior segment optical coherence tomography (AS-OCT) assessment of anterior chamber inflammation is an emerging tool. We describe the performance of AS-OCT in a paediatric population.

Methods A mixed-methods prospective study, using routine clinical assessment as reference standard, and AS-OCT, with Tomey CASIA2 or Heidelberg Spectralis HS1, as index test, with data collected on patient perceptions of imaging. Repeatability, diagnostic indices, responsiveness to clinical change and clinical correlations of imaging-based metrics (image cell count, size, density and brightness) were assessed, with construction of receiver operated characteristic curves. Exploratory thematic analysis of responses from families was undertaken.

Results A total of 90 children (180 eyes) underwent imaging. Bland Altman limits of agreement for CASIA2 repeatability ranged from +17 cells (95% CI 13.6 to 21.1) to −19 cells (95% CI −15.6 to −23.2) and HS1 from +1 (95% CI 0.9 to 1.2) to −1.0 (−1.2 to −0.8) cells. CASIA2 imaging had higher sensitivity of 0.92 (95% CI 0.78 to 0.97) vs HS1 imaging 0.17 (95% CI 0.07 to 0.34), with positive correlation between clinical grade and CASIA2 cell count (coefficient 12.8, p=0.02, 95% CI 2.2 to 23.4). Change in clinical grade at follow-up examinations correlated with change in image based ‘cell’ count (r2=0.79, p<0.001). Patients reported a potential positive impact of seeing their disease activity.

Conclusion Our findings suggest that OCT-based imaging holds the promise of deeper understanding of disease, improved patient experience and more granular monitoring of activity with resultant improved outcomes, but further work is needed to refine acquisition and analysis protocols.

  • Anterior chamber
  • diagnostic tests/investigation
  • imaging
  • inflammation
  • child health (paediatrics)

Data availability statement

Data are available on reasonable request. Aggregate data and data on protocols are available.

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Data availability statement

Data are available on reasonable request. Aggregate data and data on protocols are available.

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Footnotes

  • Twitter @Rahi_Eye_Vision, @DrXiaoLiu

  • Contributors Study design: ALS, AKD, JSR, ADD, SH and XL; data collection: KE, ALS, SA and RP; data analysis and interpretation: ALS, KE, ADD and XL; manuscript drafting and revision: all authors; supervision: ALS; Funding: ALS, SL, SA, RP and JSR. ALS conceptualised the study, and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding SA was supported by a grant from the Great Ormond Street Hospital Charity (grant number V0419). ALS is supported by an NIHR Clinician Scientist grant (grant number CS-2018-18-ST2-005). JSR is supported in part by the National Institute for Health Research Biomedical Research Centre (NIHR BRC) based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (no grant number), and an NIHR Senior Investigator award (NF-SI-0617-10031). ADD is supported by National Institute for Health Research Biomedical Research Centre (NIHR BRC) based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (no grant number) and MRC CLUSTER grant (grant number RMR/R013926/1).This work was undertaken at UCL Institute of Child Health/Great Ormond Street Hospital (no grant number) for children which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme (no grant number).

  • Competing interests None declared.

  • 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.

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