Eye disease is relatively uncommon in children. When it is present, however, optometrists may find the tasks of selecting tests, obtaining findings, and interpreting results to be more difficult. Children are often moving targets. They quickly begin to fatigue or resist testing. The optometrist may be more dependent on objective tests, due to limitations in obtaining a complete or detailed history. Young pediatric patients frequently cannot describe their symptoms, and the parent who accompanies them to their eye examination may or may not be present as the symptoms unfolded.
The potential of optical coherence tomography (OCT) to support diagnosis and management of pediatric ocular disease is particularly intriguing. OCT provides the optometrist with the ability to make microscopic retinal abnormalities clearly evident and to quantify and replicate measures of tissue structure. Patients are better able to tolerate OCT testing than other diagnostic tests—OCT is not invasive and does not require a probe contact or use of an immersion medium.1 OCT also does not require radiation exposure, which may be a particular concern in the pediatric population.2
OCT creates high-quality cross-section images of tissue structure using interferometry.1 OCT originally developed in its time domain form that uses a time comparison with a moving reference arm to determine the depth of retinal tissue.3 Stratus OCT was designed as a time domain OCT. More recently, spectral domain OCT was developed. Spectral OCT assesses the interferometric signal as a function of optical frequencies.3 This enables a much faster scanning speed and density of scanning while reducing artifacts from eye motion. This combination of increased speed with fewer artifacts from eye movements is particularly advantageous when working with pediatric patients.3 Clinicians and researchers have reported the use of OCT in children as a diagnostic tool, a tool to monitor treatment outcomes, and to investigate normal ocular tissue structure.
Diagnostic advantages of OCT
Diagnostically, OCT may be helpful to supplement visual field information or to provide information when visual field findings are not available. Visual field testing is commonly used to evaluate the visual system and to diagnose and monitor pathology. To obtain reliable visual field results, however, the patient needs to understand the test, sustain attention, and respond accurately. Research suggests that children under the age of eight years old are not reliable visual field test takers.4