• Effectiveness of SD-OCT in Detecting Elevated Intracranial Pressure in Children

    By Lynda Seminara and selected by Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, April 2017

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    Conventional techniques to detect elevated intracranial pressure (ICP) in children are invasive and often un­reliable. Swanson et al. assessed whether retinal measurements obtained by a noninvasive method, spectral-domain optical coherence tomography (SD-OCT), would be effective for this purpose. The measurements were found to have high specificity and sensitivity for detecting elevated ICP.

    This cross-sectional prospective study enrolled 79 patients treated at Children’s Hospital of Philadelphia. Of these, 40 patients had craniosynostosis, 5 had hydrocephalus and suspected elevated ICP (positive controls), and 34 were patients undergoing a minor procedure who otherwise were healthy (negative controls). All 79 participants underwent SD-OCT preoperatively. Children with cranial pathology (but not the negative controls) also underwent direct intraoperative measurement of ICP. The primary outcome measure was the association between peripapillary retinal OCT parameters and directly measured elevated ICP.

    ICP correlated positively with maximal thickness of the retinal nerve fiber layer (r = 0.60, p ≤ .001), maximal retinal thickness (r = 0.53, p ≤ .001), and maximal anterior retinal projection (r = 0.53, p = .003). Using cut points derived from the negative controls, the sensitivity of OCT parameters for detecting elevated ICP was 89%, and their specificity was 62%. The OCT measures had high intereye agreement (intraclass correlation, 0.83-0.93) and high intragrader-intergrader agreement (intraclass correlation ≥ 0.94). Conversely, the sensitivity of conventional clinical signs for detecting elevated ICP was low (11%-42%).

    The authors concluded that OCT parameters show promise as a surrogate noninvasive method for assessing ICP. SD-OCT may be transformational for at-risk patients who have factors suspicious for elevated ICP but without objective findings from currently used methods, allowing many young patients to avoid invasive procedures. (Also see related commentary by Michael C. Brodsky, MD, et al. in the same issue.)

    The original article can be found here.