The Role of Imaging and Electrophysiology in Paediatric Ocular Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (31 August 2019)

Special Issue Editor


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Guest Editor
Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA 15213, USA
Interests: pediatric ophthalmology; glaucoma; corneal disease; cataract

Special Issue Information

Dear Colleagues,

In the past twenty years, application after adaption of imaging and electrophysiology techniques used initially for adults has allowed a more intricate structural and functional evaluation of children with ocular disease. This had led to better diagnosis, better surveillance, and ultimately better outcomes for children with both rare and complex ocular diseases. The adaptation of techniques for use in children necessitates an understanding of both the behavioural approach and better attention retention to achieve reliable and repeatable results.

The use of visual evoked potentials and OCT imaging allows for structure–function correlation, and the use of serial visuals evokes potential in the evaluation of visual pathway functioning that can be used for monitoring visual pathway dysfunction in both intracranial disease and amblyopia. An understanding of the ocular ultrasound and different modalities of this can help with diagnosis, especially with optic nerve head disease. Oral fluorescein angiography can be performed safely and provide valuable information in children with retinal disease. Perhaps the most constructively disruptive technology is optical coherence tomography, and its use for paediatric ophthalmology has brought several advantages.

In this Issue, we demonstrate the combination of imaging (structure) and electrophysiology (function) to help not only the diagnosis but also the prognosis of paediatric ocular diseases.

Dr. Ken Kanwal Nischal
Guest Editor

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Keywords

  • Paediatric
  • Visual electrophysiology
  • Ocular coherence tomography
  • Ultrasound
  • Oral fluorescein angiography
  • Visual pathway

Published Papers (4 papers)

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Research

8 pages, 1574 KiB  
Article
Pre-, Intra-, and Post-Operative Evaluation of Extraocular Muscle Insertions Using Optical Coherence Tomography: A Comparison of Four Devices
by Matthew S. Pihlblad, Andrew Troia, Sapna Tibrewal and Parth R. Shah
J. Clin. Med. 2019, 8(10), 1732; https://doi.org/10.3390/jcm8101732 - 19 Oct 2019
Cited by 10 | Viewed by 2364
Abstract
OCT (optical coherence tomography) is widely used in ophthalmology and pediatric ophthalmology, but limited research has been done on the use of OCT in strabismus. This study investigates the use of different OCT machines to image rectus muscle insertions pre-, intra-, and post-operatively [...] Read more.
OCT (optical coherence tomography) is widely used in ophthalmology and pediatric ophthalmology, but limited research has been done on the use of OCT in strabismus. This study investigates the use of different OCT machines to image rectus muscle insertions pre-, intra-, and post-operatively in pediatric strabismus patients. The OCT machines used in the study were a Bioptigen (Leica Microsystems Inc., Buffalo Grove, IL, USA), Spectralis HRA+OCT with Anterior Segment Module (Heidelberg Engineering, Heidelberg, Germany), Visante (Carl Zeiss, Oberkochen, Germany), and Zeiss Rescan 700 (Carl Zeiss, Oberkochen, Germany). Measurements from the machines were compared with the caliper distance measured during the strabismus surgery before disinsertion or after reattachment. The OCT machines had moderate (Bioptigen: 0.62) to good intraclass correlation coefficients (Rescan: 0.83, Spectralis: 0.85, Visante: 0.88) with intra-operative measurements. To our knowledge, this is the first study to use an operating microscope with integrated intra-operative OCT to image rectus muscle insertions. OCT is a useful tool in strabismus surgical patients in the pre-, intra-, and post-operative settings, particularly in patients who have had previous surgery, when the muscle insertion is unknown. The ability to accurately image rectus muscle insertions has significant implications for the management of strabismus patients. Full article
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10 pages, 875 KiB  
Article
Serial, Visually-Evoked Potentials for the Assessment of Visual Function in Patients with Craniosynostosis
by Mostafa M. Haredy, Alki Liasis, Amani Davis, Kathleen Koesarie, Valeria Fu, Joseph E. Losee, Jesse A. Goldstein and Ken K. Nischal
J. Clin. Med. 2019, 8(10), 1555; https://doi.org/10.3390/jcm8101555 - 27 Sep 2019
Cited by 8 | Viewed by 2050
Abstract
This study aimed to evaluate the effect of craniofacial surgical intervention on the visual pathway’s function by comparing pre- to post-operative patterned, visually-evoked potentials (pVEP). A retrospective review was conducted on craniosynostosis patients who had pre- and post-craniofacial surgery pVEP testing. The pVEP [...] Read more.
This study aimed to evaluate the effect of craniofacial surgical intervention on the visual pathway’s function by comparing pre- to post-operative patterned, visually-evoked potentials (pVEP). A retrospective review was conducted on craniosynostosis patients who had pre- and post-craniofacial surgery pVEP testing. The pVEP measured grade in terms of amplitude latency and morphology of the waveforms. The pre- and post-operative results were compared. The study identified 63 patients (mean age at preoperative pVEP of 16.9 months). Preoperatively, 33 patients (52.4%) had abnormal pVEP. Nine patients had evidence of intracranial hypertension, and of those, eight (88.9%) had abnormal pVEP. Within 6 months postoperatively, 24 of 33 patients (72.7%) with abnormal preoperative pVEP developed normal postoperative pVEP, while all 30 patients with normal preoperative VEP maintained their normal results postoperatively. Significant improvements in pVEP latency in patients with broad or delayed latency waveforms was evident for subjects with preoperative grades 2–4 (grade 2, p = 0.015; grade 3, p = 0.029; grade 4; p = 0.007), while significant postoperative increase in amplitude was significant for patients with abnormally low amplitude grade 3 and 5 waveforms (grade 3, p = 0.011; grade 5, p = 0.029). Serial pVEP testing represents a useful tool for the early detection of visual pathway dysfunction and follow up visual pathway function in craniosynostosis. Surgical intervention for craniosynostosis can result in the reversal of preoperative pVEP abnormalities seen in these patients, resulting in the normalization of the pVEP waveform, amplitude and latency, depending on the preoperative pVEP abnormality. Full article
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8 pages, 994 KiB  
Article
Detection of Optic Disc Drusen in Children Using Ultrasound through the Lens and Avoiding the Lens—Point of Care Ultrasound Technique of Evaluation Revisited
by Renuka Rajagopal, Ellen Mitchell, Christin Sylvester, Lea Ann Lope and Ken Kanwal Nischal
J. Clin. Med. 2019, 8(9), 1449; https://doi.org/10.3390/jcm8091449 - 12 Sep 2019
Cited by 4 | Viewed by 4558
Abstract
Aim: To assess whether the detection rate of optic disc drusen (ODD) in children with swollen optic discs varies if the ultrasound scan (USS) is performed through the lens or avoiding the lens. Methods: Retrospective review of the ultrasound machine database for all [...] Read more.
Aim: To assess whether the detection rate of optic disc drusen (ODD) in children with swollen optic discs varies if the ultrasound scan (USS) is performed through the lens or avoiding the lens. Methods: Retrospective review of the ultrasound machine database for all patients who underwent USS for swollen discs in the department of pediatric ophthalmology, UPMC Children’s Hospital of Pittsburgh. Only patients who had both fundus pictures and USS performed (through and avoiding the lens) were included in the study. Results: A total of 31 patients (62 eyes) were included in the study. USS detected ODD in 44% of eyes (27 of 62 eyes, 15 patients). In 82% of these eyes (22 of 27 eyes), the ODD were not detected initially when scanning was done through the lens but were only detected when scanning was performed avoiding the lens. Ten out of sixteen patients with no ODD on USS had another identifiable cause for disc elevation, including raised intracranial pressure and sleep apnea. Conclusion: Ultrasound is a sensitive diagnostic tool for detecting ODD. The rate of detection of ODD is increased when USS is done avoiding the lens in children where the ODD are usually buried and not as calcified as those found in adults. Under such circumstances, the reduced echogenicity is absorbed by the absorbent pediatric lens, thus limiting the detection rates when scanning through the lens. Full article
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12 pages, 6725 KiB  
Article
Occipital Petalia and Albinism: A Study of Interhemispheric VEP Asymmetries in Albinism with No Nystagmus
by Alkiviades Liasis, Sian E. Handley and Ken K. Nischal
J. Clin. Med. 2019, 8(6), 802; https://doi.org/10.3390/jcm8060802 - 5 Jun 2019
Cited by 5 | Viewed by 2615
Abstract
The purpose of this study was to assess chiasmal misrouting in a cohort of children with albinism with no nystagmus using hemifield visual evoked potentials (VEP) measures. Methods: Monocular VEPs were recorded and analyzed from three electrodes (O1, Oz, and O2 referred to [...] Read more.
The purpose of this study was to assess chiasmal misrouting in a cohort of children with albinism with no nystagmus using hemifield visual evoked potentials (VEP) measures. Methods: Monocular VEPs were recorded and analyzed from three electrodes (O1, Oz, and O2 referred to Fz) from 16 children with albinism without nystagmus. Pattern reversal (full field and hemifield stimulation), full field pattern appearance and flash stimuli were used to evoke VEPs for each eye. Results: The amplitude of the pattern reversal VEPs to stimulation of the hemifield corresponding to the crossing pathways were as expected significantly larger than those to the non-crossing in each eye ((right eye p = 0.000004), (left eye p = 0.001)). Pattern reversal VEPs recorded from the left hemisphere were also larger than those from the right and most evident when comparing the crossing pathways of each eye (p = 0.004). Conclusions: This study has demonstrated electrophysiological differences in visual pathway function of the left and right hemisphere in subjects with albinism like that previously described in controls. Nasal field stimulation activated crossing and non-crossing pathways in patients with albinism and as a result, nasal hemifield VEPs in albinism are less lateralized compared to what is found in normal subjects. Full article
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