Optical coherence tomography in infants and children: A normative database and assessment of clinical use

我们的目标是使光学相干断层扫描(OCT)可用于婴幼儿的临床使用。光学相干断层扫描技术可以像显微镜一样精确地扫描活人的眼球后部(视网膜和视神经)。在过去的15年里，这为成人视网膜和视神经疾病的诊断和治疗做出了重大贡献。然而，婴幼儿由于不能与传统的OCT合作而被剥夺了诊断过程。正常的视神经和视网膜在出生时并不成熟，直到成年才会发生显著的变化。然而，到目前为止，人们对正常的出生后发育知之甚少。目前还没有针对不同年龄的标准化OCT数据，因此OCT目前不能用于儿童临床。新手持式OCT的问世使婴儿、儿童和无法合作的人可以进行扫描。然而，到目前为止，人们对其临床应用知之甚少。在过去的三年里，我们已经成功地使用手持OCT来表征正常的视网膜发育，并比较疾病中的视网膜发育。这使得我们现在可以在莱斯特眼科诊所使用OCT对儿童进行视网膜诊断。我们的目标是改进儿童OCT的获取方法，首次使用手持OCT设备可视化视神经从出生到6岁的发育过程，并建立12个不同年龄组(每组90名儿童)的视网膜和视神经的标准化数据。将在大量视力正常的儿童中进行OCT检查，以建立规范数据。我们还将扫描儿童时期各种视神经疾病的视神经，并调查OCT对诊断的帮助程度。例如，我们将观察患有视神经肿瘤(视神经胶质瘤)或儿童青光眼(眼睛高压并损害视神经)的儿童。我们将调查是否可以从各种视神经疾病的OCT扫描中预测视力。我们将调查OCT在多大程度上可以帮助改善对儿童青光眼和视神经肿瘤的监测，并减少麻醉下检查的次数。我们预计，这项研究也将有助于我们理解视神经异常的机制。我们正计划开发自动计算机程序来分析扫描过程中获得的OCT图像。这将使OCT的使用变得简单和方便，并使其能够在临床上使用。视神经发育异常和儿童视神经疾病，如青光眼，是导致儿童失明的主要原因。我们预计，我们的研究将是验证OCT的重要一步，并使OCT适用于患有视神经疾病的新生儿、婴儿和幼儿。标准数据库将为儿童使用OCT奠定基础，并将直接提供给其他OCT用户(它将与OCT公司Bioptigen Inc.共享)。手持式OCT的优化使用打开了传统眼科或验光诊所之外的广泛环境，包括术中、初级保健、发展中国家和军事医学。

Our aim is to make optical coherence tomography (OCT) accessible for clinical use in infants and young children. Optical coherence tomography provides scans of the back of the eye (the retina and optic nerve) in living people with the precision of a microscope. This has contributed, over the last 15 years, to significant progress in the diagnosis and treatment of retina and optic nerve diseases in adults. However, infants and young children have been deprived of the diagnostic progress as they cannot cooperate with conventional OCT.The normal optic nerve and retina are not mature at birth and undergo significant changes until adulthood. However, to date little is known about the normal postnatal development. There are no normative OCT data for different ages and therefore OCT can currently not be used for children clinically. The advent of a new hand-held OCT allows scanning of infants, small children and people who cannot cooperate. However, to date there is little knowledge about its clinical use. Over the last three years, we have used the hand-held OCT successfully to characterise normal retina development and to compare retinal developmental in disease. This allows us to now use OCT for retinal diagnosis in children in Leicester ophthalmology clinics. Our objective is to improve OCT acquisition methods for children, to visualise for the first time the development of the optic nerve from birth to 6 years of age using the hand-held OCT device and to establish normative data of the retina and optic nerve in 12 different age groups (90 children per group). OCTs will be performed in a large amount of children with normal eyes to establish normative data. We will also scan the optic nerve in various optic nerve diseases in childhood and investigate to what extent OCT can help with diagnosis. For example, we will look at children who have tumours of the optic nerve (optic nerve glioma) or childhood glaucoma (high pressure in the eye with damage to the optic nerve). We will investigate whether vision can be predicted from OCT scans of various optic nerve diseases. We will investigate to what extent the OCT can help to improve monitoring of childhood glaucoma and optic nerve tumours and reduce the number of examinations under anaesthesia. We anticipate that this study will also help us to understand mechanisms of optic nerve anomalies. We are planning to develop automatic computer programmes to analyse the OCT images obtained during scanning. This will make the use of the OCT easy and user-friendly and enable the use in clinics.Developmental abnormalities of the optic nerve and childhood optic nerve diseases, such as glaucoma, are leading causes of child blindness. We anticipate that our study will be an important step in validating OCT and making OCT accessible to newborns, infants and young children with optic nerve diseases. The normative database will provide the groundwork for using OCT in children and will be directly available to other OCT users (it will be shared with the OCT Company Bioptigen Inc.). The optimisation of the use of hand-held OCT opens a wide range of settings outside of the traditional ophthalmology or optometry clinics including intraoperative, primary care, developing countries and military medicine.