Duke University Eye Center, Durham, NC 27710, USA.
Exp Eye Res. 2011 Sep;93(3):299-307. doi: 10.1016/j.exer.2011.05.004. Epub 2011 May 26.
Children with large optic nerve head cups often pose diagnostic difficulty due to concern over possible glaucoma. This study's purpose was to evaluate optical coherence tomography (OCT) measurement of the peripapillary retinal nerve fiber layer (RNFL) and macular thickness in healthy eyes of black and white children, comparing values for eyes with large cup-to-disc ratios against those with small cup-to-disc ratios (normal controls). Using Stratus OCT (OCT 3) (Carl Zeiss Meditec, Dublin, CA) a fast macular thickness and fast RNFL 3.4 protocol were performed on normal eyes of normal children. Included were children (aged 5-17 years) with normal ophthalmic examinations, drawn from data generated during an ongoing study of OCT in children. Excluded were eyes with corrected vision below 20/20, spherical equivalent >5 diopters, intraocular pressure >21 mm Hg, abnormal optic nerve rim, prematurity, family history of glaucoma. Clinical examination identified children with large cup-disc-ratios (0.5-0.8), and each was matched for age and race to a "normal control" with a small cup-to-disc ratio (<0.5). OCT-3 analyses were compared between eyes with optic nerve heads showing large cup-to-disc ratios (≥0.5) vs. those showing small cup-to-disc ratios (<0.5) for different sections of the macula and the peripapillary RNFL thickness. Analyses included OCT values and optic cup grading for 162 eyes of 162 children. White children with large cup-to-disc ratios had thinner mean RNFL thickness and macular volume compared to those with small cup-to-disc ratios (average RNFL = 100 ± 9 vs. 110 ± 8 μm, respectively, p = 0.0001, macular volume = 6.84 ± 0.41 vs. 7.03 ± 0.33 mm(3), respectively, p = 0.0186). On the other hand, black children with large cup-to-disc ratios had an equivalent mean RNFL thickness and macular volume compared to those with small cup-to-disc ratios average RNFL = 107 ± 10 vs. 107 ± 8 for both groups, macular volume = 6.81 ± 0.34 vs. 6.85 ± 0.28 respectively. Positive equivalence testing assumed a clinically significant difference of 10 μm for RNFL, and 0.2 mm(3) for macular volume. We report that white children with large cup-to-disc ratios have evidence of reduced/thinner RNFL and macular volume versus white children with smaller cup-to-disc ratios, as assessed by OCT. By contrast, this distinction was not found for black children in the present study.
儿童的视神经头杯往往由于对可能的青光眼的担忧而导致诊断困难。本研究的目的是评估健康黑人和白人儿童的眼内光学相干断层扫描（OCT）测量的视盘周围视网膜神经纤维层（RNFL）和黄斑厚度，比较大杯/盘比眼与小杯/盘比眼（正常对照）的数值。使用 Stratus OCT（OCT 3）（Carl Zeiss Meditec，Dublin，CA）对正常儿童的正常眼进行快速黄斑厚度和快速 RNFL 3.4 方案。包括年龄在 5-17 岁之间的眼科检查正常的儿童，这些数据来自正在进行的儿童 OCT 研究中生成的数据。排除校正视力低于 20/20、等效球镜 >5 屈光度、眼内压 >21mmHg、视神经边缘异常、早产、青光眼家族史的眼。临床检查确定了大杯/盘比（0.5-0.8）的儿童，并且为每个儿童匹配一个小杯/盘比（<0.5）的“正常对照”。比较了视盘头部显示大杯/盘比（≥0.5）的眼与显示小杯/盘比（<0.5）的眼之间的 OCT-3 分析，比较了黄斑和视盘周围 RNFL 厚度的不同区域。分析包括 162 名儿童的 162 只眼的 OCT 值和视杯分级。与小杯/盘比（平均 RNFL=100±9 vs. 110±8μm，分别为 p=0.0001，黄斑体积=6.84±0.41 vs. 7.03±0.33mm(3)，分别为 p=0.0186）相比，大杯/盘比的白人儿童的平均 RNFL 厚度和黄斑体积较薄。另一方面，大杯/盘比的黑人儿童的平均 RNFL 厚度和黄斑体积与小杯/盘比的儿童相当，平均 RNFL=107±10 与两组均为 107±8，黄斑体积=6.81±0.34 与 6.85±0.28。正等效性检验假设 RNFL 为 10μm，黄斑体积为 0.2mm(3)，具有临床意义差异。我们报告说，白人儿童的大杯/盘比与白人儿童的小杯/盘比相比，具有降低/变薄的 RNFL 和黄斑体积的证据，这是通过 OCT 评估的。相比之下，在本研究中未发现黑人儿童存在这种差异。
