title: Evaluation of optic nerve development in preterm and term infants using handheld spectral-domain optical coherence tomography.
abstract: OBJECTIVE
  To evaluate effects of prematurity on early optic nerve (ON) development and the usefulness of ON parameters as indicators of central nervous system (CNS) development and pathology.
  
  
  METHODS
  Prospective, cross-sectional, longitudinal study.
  
  
  METHODS
  Forty-four preterm infants undergoing retinopathy of prematurity (ROP) screening and 52 term infants.
  
  
  METHODS
  We analyzed ON from portable handheld spectral-domain optical coherence tomography (SD-OCT) images (Bioptigen, Inc, Research Triangle Park, NC) of 44 preterm and 52 term infants. The highest-quality ON scan from either eye was selected for quantitative analysis. Longitudinal analysis was performed at 31-36 weeks and 37-42 weeks postmenstrual age (PMA). Preterm ON parameters also were assessed for correlation with indicators of cognitive, language, and motor development and CNS pathology.
  
  
  METHODS
  Vertical cup diameter (vCD), vertical disc diameter (vDD), vertical cup-to-disc ratio (vCDR), cup depth, and indicators of neurocognitive development and CNS pathology.
  
  
  RESULTS
  At 37-42 weeks PMA, preterm infants had larger vCD and vCDR than term infants (908 vs. 700 μm [P<0.001] and 0.68 vs. 0.53 μm [P<0.001], respectively), whereas cup depth and vDD were not significantly different. Longitudinal changes (n = 26 preterm eyes; mean interval, 4.7 weeks) in vDD and in vCDR were an increase of 74 μm (P = 0.008) and decrease of 0.05 (P = 0.015), respectively. In preterm infants (n = 44), periventricular leukomalacia was associated with larger vCD (1084 vs. 828 μm; P = 0.005) and vCDR (0.85 vs. 0.63; P<0.001), posthemorrhagic hydrocephalus was associated with shallower cup (331 vs. 456 μm; P = 0.030), and clinical magnetic resonance imaging was associated with larger vCDR (0.73 vs. 0.64; P = 0.023). In 23 preterm infants with Bayley Scales of Infant Development scores, larger vCDR was associated with lower cognitive scores (P = 0.049).
  
  
  CONCLUSIONS
  This is the first analysis of ON parameters in premature infants using SD-OCT. It demonstrated that by age of term birth, vCD and vCDR are larger in preterm infants who were screened for ROP than in term infants. In this prospective pilot study, ON parameters in these preterm infants associate weakly with CNS pathology and future cognitive development. Future prospective studies with larger numbers are necessary before further conclusions can be made.
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Tong
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Mays
authors.initials: M
authors.lastname: El-Dairi
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
authors.forename: Ramiro S
authors.initials: RS
authors.lastname: Maldonado
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Rothman
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Yuan
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Laura
authors.initials: L
authors.lastname: Kupper
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Gustafson
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Ricki F
authors.initials: RF
authors.lastname: Goldstein
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Freedman
authors.affiliation: Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina; Department of Biomedical Engineering, Duke University, Durham, North Carolina. Electronic address: cynthia.toth@dm.duke.edu.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Toth
mesh_terms: D002493:Central Nervous System Diseases / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D009900:Optic Nerve / Q000254:growth & development*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000175:diagnosis; D041623:Tomography, Optical Coherence / Q000379:methods*