Hand-held optical coherence tomography: advancements in detection and assessment of optic nerve abnormalities and disease progression monitoring

ABSTRACT Introduction Developmental abnormalities of the optic nerve (ON) and pediatric optic neuropathies, such as glaucoma, are leading causes of childhood blindness. The recent development of hand-held spectral domain optical coherence tomography (HH-OCT) has enabled noncontact, high-resolution scanning in non-sedated newborns, infants, and young children and has provided for the first time, in vivo visualization of the retina and ON in these patient groups. Areas covered This review will address the applications, recent advances, and future potential of HH-OCT in diagnosis and monitoring of pediatric optic neuropathies. We will provide an update on the use of HH-OCT in pediatric glaucoma, congenital optic disc anomalies, optic pathway gliomas, optic atrophy, and papilledema. Expert opinion HH-OCT could offer particular utility in children with optic neuropathies, by providing noninvasive, high-resolution characterization of the optic nerve head. Optic nerve parameters, such as retinal nerve fiber layer thickness, could serve as biomarkers to assess the severity of optic nerve disease qualitatively and quantitatively. Hence, HH-OCT is emerging as a powerful imaging tool to facilitate early diagnosis, identify prognostic biomarkers, monitor disease progression, and assess response to treatment.