a spectral-domain oct study of formerly premature …...background: oct zeiss cirrus hd-oct...
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A spectral-domain OCT study of formerlypremature children.
Prat Itharat MD
May 30, 2008
Vanderbilt Eye Institute
Preceptor: Dr. Recchia
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Background: Optical coherence tomography (OCT)
OCT analogous to ultrasound imaging
Non-invasive
Uses light waves
Many applications in ophthalmology
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Background: OCT
Zeiss Cirrus HD-OCT(Meditec, Dublin, CA)
Acquires 200 linear B-scans
More data pointssampled
Faster scanning time Better resolution: up to 5
microns Less concern for eccentric
fixation and technicalskills
Zeiss Stratus OCT
Acquires 6 linear B-scans Fewer data points sampled Slower scanning time Resolution: up to 10 microns More concern for eccentric fixation and technical skills
Zeiss Stratus OCTTime Domain
Zeiss Cirrus HD-OCTSpectral Domain(Meditec, Dublin, CA)
Acquires 6 linear B-scans Acquires 200 linear B-scans
Fewer data points sampled More data points sampled
Slower scanning time Faster scanning time
Resolution: up to 10 microns Better resolution: up to 5 microns
More concern for eccentric fixationand technical skills
Less concern for eccentric fixationand technical skills
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Background: SD vs TD OCT
Spectral Domain Time Domain
Courtesy of Zeiss Whitepaper
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Background: Prematurity
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Background: Prematurity
Escedy et al (2007) noted increase centralretinal thickness in formerly prematurechildren
Stratus OCT
Mainly due to presence to ROP
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Recchia et al (2007) showed OCT abnormalities inROP patients - first to suggest that changes may bevestiges of prematurity
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Recchia et al (2007) showed OCTabnormalities in ROP patients - first tosuggest that changes may be vestiges ofprematurity
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Recchia et al (2007) showed OCTabnormalities in ROP patients - first tosuggest that changes may be vestiges ofprematurity
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Limitations
Technologically
Methodologically
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Hypothesis:
OCT abnormalities are more common in
formerly premature children than in full term
children.
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OCT and prematurity
Study questions:1. Is there a difference in macular thickness
between premature and full-termchildren?
2. Is there a difference in foveal contourbetween these groups?
3. Are the OCT findings correlated to thepresence of ROP or another variable?
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Methods
IRB approval for prospective study
Records of formerly premature infantsborn prior to 1/1/2001 (treated in theVanderbilt NICU)
Control group matched for age andrefractive error
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Methods
Group I: premature with ROP (<32 weeks gestational age)
Group II: premature without ROP (<32 weeks gestational age)
Group III: full term (>36 weeks gestational age)
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Methods
Gestational age, birth weight, ROPstatus obtained from records
Cycloplegic refraction
Best corrected visual acuity
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Methods
Quantitative primary outcome measures(OCT)
-central subfield thickness
-inner (ring) macular thickness
-outer (ring) macular thickness
-total macular volume
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Methods
Qualitative primary outcome measures(OCT)
-presence of foveal depression
-preservation of retinal layers
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Methods
OCT data were reviewed by a trainedphysician (FMR) masked to the birthhistory of the patient
Quality of all scans was assessed and anyscans with a signal strength less than 8/10were discarded
For each eye, a 6 x 6 mm macular cube and5-line macular raster line scan wereinterpreted individually
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Results: Eyes
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Results:
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Results: Central subfield thickness
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Results: Inner ring retinal thickness
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Results: Outer ring retinal thickness
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Results: Total macular volume
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Results: Foveal contour
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Results: Central subfield thickness : inner ring thickness
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Results: Gestational age effect?
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Discussion:
Significant effect of gestational age
Non-significant effect of ROP
In contrast to prior studies which suggest thatROP is the major determinant of OCTabnormalities
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Discussion: Foveal development
Foveal depression occursby a reduction of inner(ganglion cell and innernuclear) layers of theretina
Evident by 24-25 weeks ofgestation
Continues until fourmonths postnatally
Diagram from Provis et al.
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Discussion: Foveal development
Mintz-Hittner et al described smaller fovealavascular zone (FAZ) in formerly prematurechildren
Provis et al showed that the formation ofthe FAZ (vascular border) precedes fovealdepression
These two processes may be interrelated
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Discussion: Foveal development
Prematurity may change retinal oxygenation
Disruption of FAZ and foveal formation-Blunted/absent foveal depression-Thickened central macula-Preservation of retinal layers
Interestingly, most of our patients had excellentvisual acuity
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Limitations
Selection bias (less severe ROP, less severeneurological disease)
Non-matched gestational age
Most ROP staging obtained indirectlythrough NICU discharge summaries
Inter-rater variability of ROP
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Conclusions
OCT findings such as increased centralmacular thickness and foveal depressionblunting may represent hallmarks ofprematurity
These findings can be associated withnormal visual acuity
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Clinical relevance
Greater use of OCT in evaluation ofpatients with decreased visual acuity
OCT abnormalities may not representocular disease
Research studies in which numericalcutoffs are made for inclusion or evaluationof therapeutic response
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Acknowledgements
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