Abstract
PurposeA central diagnostic tool in adult glaucoma is the peripapillary retinal nerve fibre layer (pRNFL) thickness. It can be assessed by scanning laser polarimetry (SLP) or optical coherence tomography (OCT). However, studies investigating the relevance of pRNFL measurements in children are rare. This study aims to compare the glaucoma diagnosing ability of SLP and OCT pRNFL thickness measurements in a paediatric population.MethodsThis retrospective study included 105 children (glaucoma: 22 (21.0%); healthy glaucoma suspects: 83 (79.0%)) aged 4–18 years, examined with SLP (GDxPro/ECC, Carl Zeiss Meditec) and spectral-domain OCT (SPECTRALIS®, Heidelberg Engineering). The thickness of pRNFL sectors was compared between diseased and healthy participants. Areas under the receiver-operating characteristic curves (AUC) and logistic regression results were used to compare the glaucoma discriminative capacity between SLP and OCT measurements.ResultsUsing OCT, pRNFL thickness was decreased in the superior, nasal, and inferior quadrants of glaucoma patients compared to healthy controls (P < 0.001, each). With SLP, such a difference was only observed in the inferior quadrant (P = 0.011). A correlation between glaucoma diagnosis and OCT-measured pRNFL thickness was found in all quadrants (P < 0.001) other than the temporal. With SLP, a correlation was found for the total average thickness (P = 0.037) and inferior quadrant (P = 0.0019). Finally, the AUCs of OCT measurements were markedly higher than those of SLP (e.g., inferior quadrant: OCT 0.83, SLP 0.68).ConclusionpRNFL thickness measurements using both OCT and SLP, correlate notably with the presence of glaucoma. In general, the diagnostic performance of pRNFL thickness measurements seems higher for OCT than for SLP. Thus, pRNFL thickness measurements could provide important information, complementing conventional clinical and functional parameters in the diagnostic process of paediatric glaucoma.
Highlights
Childhood glaucoma is defined as a group of diseases characterised by a progressive damage to retinal ganglion cells, the optic nerve, and other ocular structures due to elevated intraocular pressure (IOP) [1]
The diagnosis of childhood glaucoma is based on elevated IOP, morphologic changes of the optic nerve head (ONH), corneal abnormalities (Haab striae, enlarged diameter), progressive myopia or axial length, and glaucomatous visual field (VF) defects [3]
The present study addresses the role of peripapillary retinal nerve fibre layer (RNFL) thickness measurements for diagnosing childhood glaucoma comparing two widely available methods, scanning laser polarimetry (SLP) and SD-optical coherence tomography (OCT)
Summary
Childhood glaucoma is defined as a group of diseases characterised by a progressive damage to retinal ganglion cells, the optic nerve, and other ocular structures due to elevated intraocular pressure (IOP) [1]. The diagnosis of childhood glaucoma is based on elevated IOP, morphologic changes of the optic nerve head (ONH), corneal abnormalities (Haab striae, enlarged diameter), progressive myopia or axial length, and glaucomatous visual field (VF) defects [3]. One reason is the difficulty in performing slit lamp or fundoscopic evaluation in young patients. Their limited ability to cooperate and their short attention span further impedes the reliability of functional tests (e.g., perimetry), and IOP measurements [4]. Most of the diagnostic equipment is designed for adult rather than paediatric patients [5] and normative databases with healthy and pathologic measurements of children of various ages are lacking
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