Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska

Andrew W Arnold,1 Andrew M Eller,2 Kyle A Smith,3 Robin L Grendahl,4 R Kevin Winkle,4 Robert W Arnold4 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2University of Arkansas Medical School, Little Rock, AR, USA; 3Accurate Vision Center, Anchorage, AK, USA; 4Alaska Ch...

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Autores principales:	Arnold AW, Eller AM, Smith KA, Grendahl RL, Winkle RK, Arnold RW
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	pediatric blindness optic nerve birth defect dysmorphic retinopathy of prematurity septo-optic dysplasia Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/1b862b15f27843b29d36a5cd4bae0308
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spelling	oai:doaj.org-article:1b862b15f27843b29d36a5cd4bae03082021-12-02T09:09:10ZDirect OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska1177-5483https://doaj.org/article/1b862b15f27843b29d36a5cd4bae03082020-02-01T00:00:00Zhttps://www.dovepress.com/direct-optos-nerve-size-determination-of-prevalent-optic-nerve-hypopla-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Andrew W Arnold,1 Andrew M Eller,2 Kyle A Smith,3 Robin L Grendahl,4 R Kevin Winkle,4 Robert W Arnold4 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2University of Arkansas Medical School, Little Rock, AR, USA; 3Accurate Vision Center, Anchorage, AK, USA; 4Alaska Children’s Eye & Strabismus, Anchorage, AK 99508, USACorrespondence: Robert W ArnoldAlaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561-1917Fax +1 907 563-5373Email eyedoc@alaska.netBackground: Optic nerve hypoplasia (ONH), one of the most common causes of pediatric blindness in developed countries, has been difficult to directly quantify. We sought to measure optic nerve size in Alaskan pediatric patients with optic nerve hypoplasia using ultra-widefield fundus imaging.Methods: Adult and pediatric patients underwent conventional ultra widefield fundus imaging (OPTOS, Dunfermline, Scotland) with manual image processing to determine optic nerve size validated against refractive error and nystagmus and compared to optical spectral domain tomography. De-identified cases were then compared relative to visual acuity and birth prevalence.Results: In Alaska’s only pediatric ophthalmology outreach clinic, 108 cases of ONH less than 20 years old were clinically identified with 80 having ultra-widefield analysis. Median horizontal optic nerve diameter for 135 normals was 1.70 (95% C.I. 1.49, 2.14) whereas in patients clinically diagnosed with optic nerve hypoplasia was 1.23 (95% C.I 0.38, 1.45). Visual acuity (20/y) was related to horizontal optic nerve diameter (x) by y = 187 x-4.1. Horizontal nerve diameter h could be estimated from vertical nerve diameter v by h = 0.73v + 0.3 even in nystagmus patients. From 108 with ONH, 6 had threshold retinopathy of prematurity, 12 profound nystagmus, 32 legally blind, 6 with septo-optic dysplasia, and 5 with fetal alcohol syndrome. ONH is very prevalent in Alaska occurring at least 8– 10 per 10,000 births.Conclusion: Compared to vertical diameter, horizontal diameter was more distinctive of optic nerve hypoplasia and more perturbed by nystagmus. Both were independent of refractive error. When hand-held, spectral domain OCT is not convenient, ultra-widefield fundus analysis is recommended for direct estimation of optic nerve size in children and adults. Optic nerve hypoplasia is prevalent in Alaskan children.Keywords: pediatric blindness, optic nerve, birth defect, dysmorphic, retinopathy of prematurity, septo-optic dysplasia, OPTOSArnold AWEller AMSmith KAGrendahl RLWinkle RKArnold RWDove Medical Pressarticlepediatric blindnessoptic nervebirth defectdysmorphicretinopathy of prematuritysepto-optic dysplasiaOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 491-499 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	pediatric blindness optic nerve birth defect dysmorphic retinopathy of prematurity septo-optic dysplasia Ophthalmology RE1-994
spellingShingle	pediatric blindness optic nerve birth defect dysmorphic retinopathy of prematurity septo-optic dysplasia Ophthalmology RE1-994 Arnold AW Eller AM Smith KA Grendahl RL Winkle RK Arnold RW Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska
description	Andrew W Arnold,1 Andrew M Eller,2 Kyle A Smith,3 Robin L Grendahl,4 R Kevin Winkle,4 Robert W Arnold4 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2University of Arkansas Medical School, Little Rock, AR, USA; 3Accurate Vision Center, Anchorage, AK, USA; 4Alaska Children’s Eye & Strabismus, Anchorage, AK 99508, USACorrespondence: Robert W ArnoldAlaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, AK 99508, USATel +1 907 561-1917Fax +1 907 563-5373Email eyedoc@alaska.netBackground: Optic nerve hypoplasia (ONH), one of the most common causes of pediatric blindness in developed countries, has been difficult to directly quantify. We sought to measure optic nerve size in Alaskan pediatric patients with optic nerve hypoplasia using ultra-widefield fundus imaging.Methods: Adult and pediatric patients underwent conventional ultra widefield fundus imaging (OPTOS, Dunfermline, Scotland) with manual image processing to determine optic nerve size validated against refractive error and nystagmus and compared to optical spectral domain tomography. De-identified cases were then compared relative to visual acuity and birth prevalence.Results: In Alaska’s only pediatric ophthalmology outreach clinic, 108 cases of ONH less than 20 years old were clinically identified with 80 having ultra-widefield analysis. Median horizontal optic nerve diameter for 135 normals was 1.70 (95% C.I. 1.49, 2.14) whereas in patients clinically diagnosed with optic nerve hypoplasia was 1.23 (95% C.I 0.38, 1.45). Visual acuity (20/y) was related to horizontal optic nerve diameter (x) by y = 187 x-4.1. Horizontal nerve diameter h could be estimated from vertical nerve diameter v by h = 0.73v + 0.3 even in nystagmus patients. From 108 with ONH, 6 had threshold retinopathy of prematurity, 12 profound nystagmus, 32 legally blind, 6 with septo-optic dysplasia, and 5 with fetal alcohol syndrome. ONH is very prevalent in Alaska occurring at least 8– 10 per 10,000 births.Conclusion: Compared to vertical diameter, horizontal diameter was more distinctive of optic nerve hypoplasia and more perturbed by nystagmus. Both were independent of refractive error. When hand-held, spectral domain OCT is not convenient, ultra-widefield fundus analysis is recommended for direct estimation of optic nerve size in children and adults. Optic nerve hypoplasia is prevalent in Alaskan children.Keywords: pediatric blindness, optic nerve, birth defect, dysmorphic, retinopathy of prematurity, septo-optic dysplasia, OPTOS
format	article
author	Arnold AW Eller AM Smith KA Grendahl RL Winkle RK Arnold RW
author_facet	Arnold AW Eller AM Smith KA Grendahl RL Winkle RK Arnold RW
author_sort	Arnold AW
title	Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska
title_short	Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska
title_full	Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska
title_fullStr	Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska
title_full_unstemmed	Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska
title_sort	direct optos nerve size determination of prevalent optic nerve hypoplasia in alaska
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/1b862b15f27843b29d36a5cd4bae0308
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Direct OPTOS Nerve Size Determination of Prevalent Optic Nerve Hypoplasia in Alaska

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