Normative retinal thickness values in children, measured by swept-source optical coherence tomography.

Abstract

Background: Although optical coherence tomography (OCT) has become essential in pediatric ophthalmology, normative data for children are lacking in most device databases. Due to ongoing ocular growth and developmental changes that occur during childhood and adolescence, adult reference values are not appropriate for pediatric use. Additionally, OCT measurements vary across devices, indicating the need for device-specific norms. In this study, we aimed to establish normative values for total macular retinal thickness, macular ganglion cell layer (GCL+) thickness, and circumpapillary retinal nerve fiber layer (cpRNFL) thickness in children aged 5-17 years relevant to the Topcon DRI Triton Plus swept-source OCT device.

Methods: We recruited children aged 5-17 years with normal ocular health, adequate visual acuity, and refractive errors within ±3.00 diopters (D) spherical and ≤ -1.00 D cylindrical under cycloplegia. Each child underwent comprehensive eye examinations and four OCT scans (two macular and two optic disc scans) using the Topcon DRI Triton Plus. Retinal thickness measurements were obtained from the eye with better visual acuity, or from a randomly selected eye in cases where both eyes had similar acuity. Scans were included if image quality was ≥40 and were free from artifacts or segmentation errors. Measurements were compared between age groups (5-7 and 8-17 years). Intra-visit repeatability was assessed using test-retest correlations based on repeated measurements obtained by the same examiner during a single visit.

Results: Sixty-nine children (n = 33, 48% girls), with a median age of 7 years (5-7-year age group) and 13 years (8-17-year age group) were included. The total macular thickness was 287.5 µm (11.1) and 290.5 µm (13.8), GCL+ thickness was 75.7 µm (4.2) and 74.9 µm (5.2), and cpRNFL thickness was 111.5 µm (10.2) and 108.3 µm (7.9) for the 5-7-year and 8-17-year age groups, respectively (mean [standard deviation]). Mean retinal thickness measures did not differ significantly by age or sex (all P > 0.05). Correlation between repeated measurements showed excellent repeatability: 0.991 for both total macular and GCL+ thickness, and 0.954 for cpRNFL (all P < 0.001). Spherical equivalent did not correlate significantly with retinal thickness measures (all P > 0.05).

Conclusions: This study provided normative values for macular total retinal thickness, macular GCL+ thickness, and cpRNFL thickness in children aged 5-17 years, measured using the Topcon DRI Triton Plus OCT device. We observed no significant age- or sex-based differences in these values, and measurement repeatability was excellent. Given the variability in retinal thickness across populations and devices, region- and device-specific pediatric norms are essential. These findings fill a critical gap in pediatric OCT normative databases and contribute to the development of reliable pediatric reference standards for swept-source OCT imaging. This may enhance diagnostic accuracy and clinical decision-making in pediatric ophthalmology.