Photo Credit: Rabizo

Swept-source anterior-segment OCT visualizes anterior angles in children and may help distinguish pediatric glaucoma from other conditions.

Swept-source anterior-segment optical coherence tomography (SS-ASOCT), a noninvasive imaging tool, effectively analyzes anterior chamber angles in children and has the potential to differentiate early-onset childhood glaucoma from other conditions, according to findings published in JAMA Ophthalmology.

“Early-onset childhood glaucoma usually is diagnosed based on signs and symptoms (such as a cloudy cornea, buphthalmos, or excessive lacrimation),” researchers wrote. “However, the signs and symptoms can overlap with other congenital conditions, making differentiation important. SS-ASOCT may offer a rapid, noninvasive alternative to assess the trabecular meshwork (TM) structures, providing an additional tool to aid diagnosis.”

The study team conducted a prospective, comparative study of pediatric patients aged less than 2 years. The diagnosis of early-onset childhood glaucoma was based on the clinical appearance of corneal clarity, intraocular pressure, buphthalmos, and optic disc assessment.

In total, SS-ASOCT features were compared between 23 pediatric patients without early-onset childhood glaucoma and 30 pediatric patients with early-onset childhood glaucoma. The 30 patients with glaucoma were diagnosed based on an eye examination with an ophthalmoscope.

Efficacy of SS-ASOCT Imaging

At the time of SS-ASOCT imaging, pediatric patients without glaucoma had a mean age of 17.3 months, while pediatric patients with glaucoma had a mean age of 18.6 months.

The TM shadow was visible in 23 patients without glaucomatous eyes (100.0%), but only clearly visible in eight patients with glaucomatous eyes (26.7%), resulting in a sensitivity of 73.3% and a specificity of 100.0%.

To diagnose pediatric patients as not having early-onset childhood glaucoma, the highest area under the receiver operating characteristic curve—0.87 (95% CI, 0.77-0.97; P<0.001)—was used for a visible TM structure, according to the study results. Pediatric patients with glaucoma had higher anterior chamber angle measurement values than pediatric patients without glaucoma, and the TM structure was observable in all young children with corneal opacity who did not have glaucoma. Further, all 23 patients without glaucoma were correctly diagnosed as not having glaucoma using SS-ASOCT.

“The findings suggest the use of SS-ASOCT offers the potential for distinguishing early-onset childhood glaucoma from other conditions,” the researchers wrote. “No visibility of the TM structure was the most specific sign for glaucomatous eyes in this relatively small cohort.”