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  • Pediatric Ophth/Strabismus

    Review of: Modernizing the evaluation of infantile nystagmus: The role of handheld optical coherence tomography

    Joseph S, Naithani R, Alvarez S, et al. Journal of the American Association for Pediatric Ophthalmology and Strabismus, June 2024

    Handheld OCT (HH-OCT) has the potential to simplify the evaluation of children with infantile nystagmus and diagnose retinal abnormalities without the use of more invasive procedures.

    Study Design

    This was a retrospective case series of 39 children with infantile nystagmus who had undergone HH-OCT imaging of ≥1 optic nerve head (ONH) and macula. Patients with Down syndrome and those with other ocular conditions, such as retina/optic nerve pathology, cataract, aniridia, or corneal opacity, were excluded. Masked HH-OCT findings were evaluated by a pediatric neuro-ophthalmologist and a pediatric ophthalmologist.


    Because conditions such as ONH hypoplasia and foveal hypoplasia were able to be established by HH-OCT, the percentage of electroretinograms (ERGs) and magnetic resonance images (MRIs) ordered decreased by 64% and 14%, respectively, compared with recommendations from the initial workup. Furthermore, HH-OCT identified the etiology of the infantile nystagmus in 77% of patients, including abnormalities of the optic nerve, fovea, and retina.


    The number of patients in the study was relatively low. In addition, the availability of HH-OCT in many practices is limited. Finally, given its retrospective nature, the study did not include specific information as to the type, amplitude, and frequency of the nystagmus.

    Clinical Significance

    This HH-OCT–based algorithm could help clinicians in their workup of infants presenting with nystagmus, and might also be a tool for decreasing unnecessary tests, such as ERGs and MRIs, that require anesthesia or sedation in these very young patients.

    Financial Disclosures: Dr. Brenda Bohnsack discloses no financial relationships.