The Paediatric Glaucoma Diagnostic Ability of Optical Coherence Tomography: A Comparison of Macular Segmentation and Peripapillary Retinal Nerve Fibre Layer Thickness

Simple Summary Optical coherence tomography (OCT) is an established ophthalmologic diagnostic tool to visualise vital retinal structures. In glaucoma, it is used to quantify the thickness decrease in the peripapillary retinal nerve fibre layer (pRNFL) and in the macula. While glaucoma management in adults incorporates traditional clinical parameters as well as instrumental methods such as OCT, guidelines for paediatric glaucoma focus on conventional methods. Even though some reports encouraging a broader use of OCT in children are present, its diagnostic potential in this particular population has still not been sufficiently analysed. To address this, the present study compares the glaucoma discriminative ability of OCT measurements of the pRNFL and macular layers in a paediatric population. The results indicate a reduction of the pRNFL and of inner macular layer thickness in glaucoma eyes, as well as a high correlation with the presence of glaucoma. The glaucoma discriminative ability can be maximised combining either all pRNFL sectors or the thickness results of the three innermost macular layers, even though sensitivity remains moderate. In conclusion, the OCT measurements of the pRNFL and macular thickness have a strong ability to diagnose paediatric glaucoma. However, OCT should be used in addition to conventional diagnostic tools rather than as a standalone method. Paediatric glaucoma leads to a decreased thickness of the peripapillary retinal nerve fibre layer (pRNFL) and of the macula. These changes can be precisely quantified using spectral domain-optical coherence tomography (SD-OCT). Despite abundant reports in adults, studies on the diagnostic capacity of macular SD-OCT in paediatric glaucoma are rare. The aim of this study was to compare the glaucoma discriminative ability of pRNFL and macular segment thickness in paediatric glaucoma patients and healthy children. Data of 72 children aged 5-17 years (glaucoma: 19 (26.4%), healthy: 53 (73.6%)) examined with SD-OCT (SPECTRALIS(R), Heidelberg Engineering) were analysed retrospectively. The thickness of pRNFL sectors and of macular segment subfields were compared between diseased and healthy participants. Areas under the receiver-operating characteristic curves (AUC), sensitivity, and specificity from logistic regression were used to evaluate the glaucoma discriminative capacity of single and combined pRNFL and macular segments' thickness. The results revealed a reduced thickness of the pRNFL and of the three inner macular layers in glaucoma patients, which correlates highly with the presence of glaucoma. The highest glaucoma discriminative ability was observed for the combination of pRNFL sectors or inner macular segments (AUC: 0.83 and 0.85, respectively), although sensitivity remained moderate (both 63% at 95% specificity). In conclusion, while confirmation from investigations in larger cohorts is required, SD-OCT-derived pRNFL and macular thickness measurements seem highly valuable for the diagnosis of paediatric glaucoma.

Automated summary

Optical coherence tomography (OCT) is a valuable tool for diagnosing pediatric glaucoma by quantifying thickness reduction in the peripapillary retinal nerve fiber layer (pRNFL) and macula. Studies have shown a correlation between reduced pRNFL and inner macular layer thickness and the presence of glaucoma in children. Combining pRNFL sectors or inner macular layers can enhance the diagnostic ability, although sensitivity may vary.