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June 8, 2009

Technological Advances in Pediatric Eye Care

Arch Ophthalmol. 2009;127(6):805-806. doi:10.1001/archophthalmol.2009.133

The application of new technology is changing the practice of ophthalmology. New imaging devices, surgical procedures, and use of the Internet and powerful computers are examples of advances that have made a major impact on ophthalmology. Although pediatric ophthalmologists may not have as many new tools or treatments as our colleagues in cornea, glaucoma, or retina, our practices have nonetheless been enhanced significantly in recent years by technological advancements.

New imaging devices, such as optical coherence tomography (OCT), have allowed us to view details of ocular anatomy that heretofore were not visible. Optical coherence tomography has become widely used in adults, both for the diagnosis and monitoring of glaucoma (and other optic neuropathies) and macular diseases. While this technology holds promise in its application to pediatric optic nerve and macular disorders, pediatric normative values are just recently being published for retinal nerve fiber layer (RNFL) and macular thicknesses.1-4 Interestingly, normative values for these OCT parameters vary not only with age and axial length, but also with race.1-4 Monitoring children with glaucoma for stability is challenging, especially in those unable to cooperate for reliable visual field testing; OCT measurements of the RNFL and macular thickness may provide a quantitative indicator for optic nerve function. Hence, El-Dairi el al5 reported thinning of the RNFL and macula with increasing optic nerve damage (by stereophotography) in children with glaucoma. Other uses of posterior segment OCT in children include measuring RNFL changes in papilledema or optic atrophy and studying foveal morphology in ocular albinism, retinopathy of prematurity, traumatic retinopathy, retinoschisis, retinitis pigmentosa, and other less common retinal degenerative diseases. The newer-generation spectral-domain OCT can accurately scan the fovea despite the presence of nystagmus.6 Anterior segment OCT has been applied in myopic children to document the thickness of both the ciliary body and lens. In adults, anterior segment OCT has been used to evaluate angle structures and anterior chamber glaucoma drainage tubes, but published reports of pediatric anterior segment OCT remain few.

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