Assessment of macular ganglion cell complex using optical coherence tomography: impact of a paediatric reference database in clinical practice.

IMPORTANCE: Optical coherence tomography software classifies abnormality of macular ganglion cell-inner plexiform layer thickness and macular retinal nerve fibre layer thickness based on adult series.

BACKGROUND: We assessed the impact of using paediatric reference macular ganglion cell complex values instead of adult reference values.

DESIGN: Cross-sectional study. Primary and tertiary health-care setting.

PARTICIPANTS: Out of 140 healthy participants aged 5 to 18 years, 90% were eligible.

METHODS: Following a dilated eye examination and cycloplegic refraction, participants underwent optical coherence tomography ganglion cell scans (Topcon 3D OCT-2000). Right eye measurements for superior, inferior, and total layer thickness, and spherical equivalent were reported, together with age, sex, and origin.

MAIN OUTCOME MEASURES: Paediatric reference values by age and spherical equivalent were produced, and the specific agreement between paediatric and adult ganglion cell complex reference values below or equal to percentile 5 was estimated.

RESULTS: The multivariate analysis confirmed a positive association between spherical equivalent and macular ganglion cell-inner plexiform layer thickness and between age and macular retinal nerve fibre layer (5 out of 6 regression coefficients p-values were <0.3). Specific agreement was 25% for ganglion cell-inner plexiform layer thickness and >80% for macular retinal nerve fibre layer. Adult-based software identified low ganglion cell values in 1 in 7 children compared to paediatric reference values (0.8% vs. 5.5%, p=0.031).

CONCLUSIONS AND RELEVANCE: The availability of optical coherence tomography ganglion cell complex reference values for paediatric age and spherical equivalent groups can be used to improve detection of children with low cell layer thickness.