Utility of Swept-Source Anterior-Segment OCT as an In-Office Biomarker for Early Childhood Glaucoma.

Importance Early-onset childhood glaucoma usually is diagnosed based on signs and symptoms (such as a cloudy cornea, buphthalmos, or excessive lacrimation). However, the signs and symptoms can overlap with other congenital conditions, making differentiation important. Swept-source anterior-segment optical coherence tomography (SS-ASOCT) may offer a rapid, noninvasive alternative to assess the trabecular meshwork (TM) structures, providing an additional tool to aid diagnosis. Objective To evaluate use of SS-ASOCT in diagnosing pediatric patients as having early-onset childhood glaucoma vs not having glaucoma. Design, Setting, and Participants A prospective, comparative study including pediatric patients younger than 2 years of age who were referred to a tertiary care research and referral center in Northern India between June 2023 and July 2024. A diagnosis of early-onset childhood glaucoma was based on the clinical appearance of corneal clarity, intraocular pressure, buphthalmos, and optic disc evaluation. Main Outcomes and Measures Imaging was performed using SS-ASOCT with the "flying baby" technique to analyze the visibility of the TM structures, the angle opening distance (500 mm or 250 mm), and the angle recess area (250 mm2 or 500 mm2). Comparisons were made using analysis of variance. The area under the receiver operating characteristic curve was used to determine the discriminators for the nonglaucomatous angles. The best discriminatory parameters studied were subsequently tested in age-matched infants (controls) with congenital cloudy corneas without glaucoma based on an eye examination using an ophthalmoscope. Results The SS-ASOCT features were compared between 23 pediatric patients without and 30 pediatric patients with early-onset childhood glaucoma; the 30 patients were diagnosed as having glaucoma based on an eye examination using an ophthalmoscope. At the time of SS-ASOCT imaging, the pediatric patients without glaucoma had a mean age of 17.3 (SD, 4.4) months and the pediatric patients with glaucoma had a mean age of 18.6 (SD, 14.2) months. The TM shadow was clearly visible in 23 patients without glaucomatous eyes (100%), whereas the TM shadow was clearly visible in only 8 patients with glaucomatous eyes (26.7%) (sensitivity of 73.3% and specificity of 100%). To diagnose pediatric patients as not having early-onset childhood glaucoma, the highest area under the receiver operating characteristic curve of 0.87 (95% CI, 0.77-0.97; P < .001) was used for a clearly visible TM structure. The pediatric patients with glaucoma had greater anterior chamber angle measurement values than the pediatric patients without glaucoma. The TM structure was visualized in all young children with corneal opacity but who did not have glaucoma, and all 23 patients were correctly diagnosed as not having glaucoma using SS-ASOCT. Conclusions and Relevance A noninvasive imaging tool, SS-ASOCT can be used to assess the anterior chamber angles in children. The findings suggest the use of SS-ASOCT offers the potential for distinguishing early-onset childhood glaucoma from other conditions. No visibility of the TM structure was the most specific sign for glaucomatous eyes in this relatively small cohort.