In Vivo Studies of Normal and Abnormal Development of the Anterior Chamber of Children Eye using Hand-held Spectral Domain Optical Coherence Tomography

Background: In-vivo postnatal normative development of the anterior chamber of the eye of children has not been investigated. The availability of a portable hand-held non-invasive optical coherence tomography (HH-OCT) can facilitate such investigations. However, HH-OCT application in imaging the anterior chamber has not been optimised and validated for imaging the anterior chamber of the eye. This study aims to test the feasibility and reproducibility of HH-OCT for imaging the anterior chamber and investigates the normal and abnormal postnatal development of the anterior chamber of children. Methods: HH-OCT was used for imaging the anterior chamber of healthy children and children with congenital glaucoma, prematurity, nystagmus and anterior segment abnormalities. HH-OCT feasibility and reproducibility were tested in healthy children and children with nystagmus and congenital glaucoma < 6 years of age. The normal development of anterior chamber was investigated in 265 children. The abnormal development of the anterior chamber of children with congenital glaucoma and prematurity was compared to age-matched controls. Results: We showed that HH-OCT has 89% feasibility, excellent repeatability and reproducibility in imaging the anterior chamber of children with ICC of > 0.9 for anterior chamber angle width measurements. We found that normal development of the anterior chamber is non-linear and occurs rapidly during the first year of age and reaches maturity by the age of 5 years. This study showed that females have smaller anterior chamber measurements compared to males and an association of anterior chamber development to the myopic shift during emmetropisation. Children with congenital glaucoma had significantly wider anterior chamber angle and greater anterior chamber width compared to age-matched controls. Premature born children had delayed development of anterior chamber compared to age-matched controls. HH-OCT is a useful method for assessing the anterior chamber of children with anterior segment abnormalities. Conclusions: This thesis presents in-vivo measurements of the anterior chamber of healthy children and children with anterior chamber pathology using HH-OCT, for the first time, with excellent feasibility and repeatability. HH-OCT is a useful method for evaluating the development of anterior chamber of children.