Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 196993

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : NC01 - NC04 Full Version

Retinal Vessel Parameters and Choroidal Thickness using Optical Coherence Tomography and OCT Angiogram in Normal Children: A Cross-sectional Study


Published: August 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56707.16693
Florida Selus, Saban Horo, Thomas Kuriakose, Mahasampath Gowri, Deepa John

1. Optometrist, Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India. 2. Professor, Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India. 3. Professor, Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India. 4. Lecturer, Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India. 5. Professor, Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India.

Correspondence Address :
Dr. Saban Horo,
Professor, Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India.
E-mail: sabanhoro@gmail.com; fabflo43@gmail.com

Abstract

Introduction: Optical Coherence Tomography (OCT) and OCT Angiogram (OCT-A) are non invasive techniques for imaging the microvasculature of retina and choroid. OCT is a method of analysing the in-vivo retinal architecture. OCT uses low coherence interferometry to create a cross-sectional map of the retina with a resolution of 10-15 μm. Swept Source OCT utilises light source of 1050 nm wavelength and can reproducibly measure choroidal thickness. OCT-A uses the principle of motion contrast, where the moving red blood cells are traced to depict vessels through different segments of the retina. The same tissue area is imaged repeatedly and differences are analysed between scans to detect area with high flow rates, low flow and no flow at all. Only a few studies have been reported on baseline choroidal thickness and retinal vessel parameters in children. This study was conducted to measure these parameters using Swept source OCT in normal children.

Aim: To measure retinal vasculature parameters and choroidal thickness using OCT and OCT-A in normal children.

Materials and Methods: A cross-sectional study was conducted on 68 children between 5-15 years of age in Department of Ophthalmology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India between February to July 2018, after obtaining the ethical clearance from the Institutional Review Board. The children were divided into two groups, 5-10 years and >10-15 years. Children with Best Corrected Visual Acuity (BCVA) <6/6, axial length <20/>25 mm, any systemic disease or ocular pathology were excluded. All underwent comprehensive ophthalmic examination along with fundus photography, OCT and OCTA imaging. Retinal artery and vein calibre at the disc margin and Subfoveal Choroidal Thickness (SFCT) were measured. Measurement of Foveal Avascular Zone (FAZ) both superficial and deep, Vascular Density (VD) of perifoveal, papillary and peripapillary area were obtained from OCT-A. T-test was used to compare the parameters with p-value <0.05 considered as significant.

Results: A total of 136 eyes were included. Mean retinal artery measured at superior and inferior disc margin was 176.84±43.88 μm and 177.78±41.69 μm respectively. Mean retinal vein measured at superior and inferior disc margin was 218.90±46.36 μm and 235.37±48.07 μm respectively. Perifoveal images were clear and vessel densities could be anlaysed but papillary and peripapillary vessel densities were not analysed due to poor image quality in many subjects. The mean retinal artery caliber in the age group 5-10 years was 179.85±45.62 μm and 174.00±42.30 μm in the age group >10-15 years at the superior disc margin with p-value of (0.4403). There was no statistical difference retinal vessel caliber between the two groups. The mean SFCT in the 5-10 years group was 344.42±86.77 μm and 343.40± 93.56 μm in the other with a p value 0.9474. The mean superficial FAZ (SFAZ) was 189.79±117.11 μm2 in the first group and 264.88±169.91 μm2 in the second group, (p=0.0034). There was no statistical difference among these parameters between the two groups except SFAZ.

Conclusion: Present study describes the normative data on retinal vasculature parameters and choroidal thickness in Indian paediatric population aged 5-15 years using OCT and OCT-A. The study findings will further help in screening and monitoring the subjects in this age group.

Keywords

Choroidal imaging, Paediatric retina, Retinal vasculature

The OCT and OCT-A are non invasive techniques used for imaging retina and choroid (1),(2). Microvascular changes in retina can be identified by these techniques well ahead of it being identified clinically. Retinal vessel caliber changes, microvascular changes in the deeper retinal layers and choroidal vessel changes are potent biomarkers for various systemic and ocular conditions, especially diabetes and hypertension (3),(4),(5). Prevalence of various vascular diseases in children are on the rise (6). Hypertension has the strongest association with retinal vascular calibers. In diabetes, the microvascular changes plays an important role in its pathogenesis and has shown a relation with retinal vessel calibers. Cardiovascular risk factors are also associated with retinal vessel dimensions. Stroke, obesity, dyslipidaemia, cognitive impairment and kidney diseases are other few conditions where retinal vessel caliber show changes and can act as a marker. Detecting these retinal and choroidal changes early can help diagnose and modify treatments to avoid the long-term vascular complications in these diseases (7),(8). Studies on retinal and choroidal vessels in normal adults have been studied and reported (9),(10),(11). However, the information on these vascular parameters in normal children are limited in the literature (12),(13),(14),(15),(16),(17). The data is even more scarce in the Indian paediatric population (14). Children with hypertension with retinal vascular changes are seen and there was no normative data to compare. The objective of present study was to document retinal and choroidal vascular parameters in children from Indian population. Thus, the participants were divided into two groups, 5-10 years and >10-15 years. The null hypothesis made was that there was no difference in parameters among the two age groups.

Material and Methods

A cross-sectional study was conducted in children visiting outpatient clinic in the Department of Paediatric Ophthalmology, Christian Medical College and Hospital, Vellore a tertiary care centre in Tamil Nadu, India, from February to July 2018. Institutional Review Board (IRB) clearance was obtained, IRB No:11100 dated 10/01/18. An informed consent was obtained from the parents or guardians of each participant and a written assent was obtained from children above 8 years and an oral assent for children below 8 years. Visual acuity of all the participants was 6/6.

Sample size calculation: Based on the study taken for sample size, the mean SFCT reported was 312.1±45.5 (14). The calculated sample size of 64 eyes with 95% CI was done using the following formula, n=4*SD*SD/(d*d) and got, for 40 SD and precision of 10 units. The sample size calculated was 64 eyes in 5-10 years and 64 eyes in >10-15 years accounting for 128 eyes. Considering poor image quality of 5% eight eyes additionally were recruited.

Inclusion criteria: Children between 5-15 years were included in the study.

Exclusion criteria: Children younger than 5 years were excluded expecting poor cooperation and assuming poor quality images. A detailed history was taken from the parent on child’s systemic medications or illness like hypertension, diabetes, renal disease or parental history of hypertension and birth history like low birth weight (<2.5 kg) or prematurity (<37 weeks), if any present, were excluded. Body Mass Index (BMI) was calculated and children with BMI >25 were excluded. Children with syndromic disorder were also excluded.

Study Procedure

Retinal artery and vein calibre at the disc margin were measured from the fundus photograph. SFCT and choroid thickness 1 mm horizontally on either side of the fovea was measured from the OCT image. Measurement of FAZ both superficial and deep, Vascular Density (VD) of perifoveal, papillary and peripapillary area were measured from OCT-A. Ocular factors which alters the retinal vascular parameters and choroidal thickness like Axial Length (AXL) >25 mm or <20 mm, highmyopia (>-6 Diopter (D) or hyperopia (>+4D) were excluded. After routine comprehensive ophthalmic examination, charts were screened for any ocular pathology that might affect the outcome and were excluded. Children who met the inclusion/exclusion criteria underwent fundus photography, OCT and OCT-A imaging. Images were screened and any retinal or choroidal abnormality detectable on OCT scan, poor image quality because of unstable fixation and who were unable to cooperate for SS-OCT examination were also excluded. Fundus photo was taken at one time to reduce contact time as the study was conducted in normal children. There is a probability of arteriolar diameter varying in different phase of cardiac cycle in children also. Both eyes of each patient were included in the study.

Measurements obtained:

• The retinal vessel caliber at superior and inferior optic disc margin, from fundus photography.
• Choroidal thickness at the foveal region, 1 mm nasal and 1 mm temporal to fovea, from OCT images.
• Measurement of FAZ both superficial and deep, from OCT-A images.
• Vascular density of parafoveal, papillary and peripapillary area from OCT-A images.

This study was done using Swept Source OCT (SS OCT – DRI OCT TRITON Plus, TOPCON Inc, Tokyo, Japan) which uses light reflectance off the surface of retina. Light emitted from SS-OCT utilises a longer wavelength, close to 1050 nm which captures retinal and choroid images within 30 seconds. This advanced vascular imaging technique allows detailed non invasive assessment of retinal microvasculature. OCT-A captures images of moving red blood cells thus accurately depicting vessels through different segmented areas of the retina.

Vessel diameter: The fundus image was exported from OCT macula and the vessel calibers were measured using the inbuilt caliper, both arteriolar and venular diameter while exiting at superior and inferior optic disc margin and where the artery and vein were overlapping the measurements were not taken for analysis. The values were obtained in pixels and converted to μm. An average of three readings were taken and multiplied by 10 based on machines conversion for pixels in fundus image.

Subfoveal and parafoveal choroidal thickness: The choroidal thickness was measured from OCT macula horizontal 6 mm line scan. The thickness of choroid was measured from retinal pigment epithelial layer superiorly to the lower choroidal vascular extent at the fovea manually using the inbuilt caliper, 1 mm nasal and 1 mm temporal to fovea. Three readings were taken and average was taken in μm.

Foveal avascular zone: The foveal avascular zone superficial and deep images were exported from OCT-A macula scan and the borderline of FAZ were traced manually using the inbuilt tool and the area was derived. The values were obtained in pixels and were converted to μm2.

Vascular density: Over optic disc, 3 mm around the disc and 3 mm around the centre of fovea was analysed using the Image J software (Table/Fig 1), an open source, which is a Java-based image processing program developed at the National Institutes of Health and the Laboratory for Optical and Computational Instrumentation (LOCI, University of Wisconsin) (18). The vessel analysis protocol calculated the vessel density metrics using the following formula:

Vascular density=Vessel area/Total area of image ×100 percentage area

Statistical Analysis

Data was entered in Microsoft excel spread sheet and was analysed using STATA version 15.0. The continuous variables like retinal vessel calibre, choroidal thickness, FAZ area and VD were reported by using mean and Standard Deviation (SD). The categorical variables like gender and age group were analysed and were represented as number and percentages. Age groups 5-10 years and >10-15 years were analysed separately and compared using unpaired t-test with p-values to look for any physiological variations between these age groups. Paired t-test was used to compare the differences in right and left eye. A p-value of <0.05 was taken as significant. Subgroup analysis of superior and inferior vessel calibre, temporal and nasal CT, deep and superficial FAZ, Superficial and deep perifoveal VD were also compared using paired t-test.

Results

A total of 435 children were recruited for the study of which 298 were excluded due to ocular pathology and 42 were excluded due to systemi cillness/medications, 27 were excluded due to poor co-operation for imaging or poor image quality. A total of 136 eyes of 68 children were included. Mean age was 11.05±2.61 years. A total 33 children belonged to 5-10 years and 35 were from >10-15 years. Males were 38 (56%).

The retinal and choroidal parameters among the study population are shown in (Table/Fig 2). The retinal artery caliber at superior and inferior disc margins were almost the same but the retinal vein did show some difference of 16.47 μm with inferior vein caliber being larger. Mean retinal artery measured at superior and inferiror disc margin was 176.84 micrometer (μm) (+/-43.88) and 177.78±41.69 μm respectively. Mean retinal vein measured at superior and inferiror disc margin was 218.90±46.36 μm and 235.37 ±48.07 μm respectively. The subfoveal choroidal thickness was 343.89±89.99 μm which was more than temporal and nasal thickness. The deep foveal avascular zone area was 249.37±151.55 μm2 which was larger than the superficial foveal avascular zone. The perifoveal superficial vessel density was 59.71±3.33 % which was less than the deep by 7.04%.

Papillary and peripapillary vascular densities could not be analysed as the sample was low due to poor image quality in many subjects.

The (Table/Fig 3) shows the comparison between superficial and deep foveal avascular zone, perifoveal vessel density and choroidal thickness. The deep foveal avascular zone area was larger than the superficial and was statistically significant with a p-value=0.009. There was a statistical significant difference between the deep perifoveal vessel density and the superficial with a p-value <0.001, the deep being larger. There was no difference between the nasal and temporal choroidal thickness.

The comparison between the two groups 5-10 years and >10-15 years is given in (Table/Fig 4). It compares the various retinal vascular parameters and choroidal thickness among them. The retinal artery and vein caliber at superior and inferior disc margins were same between the groups. There was no difference in the choroidal thickness and perifoveal vessel density in both groups, but SFAZ did show a significant difference.

Papillary and peri papillary vascular densities could not be analysed as the sample was low due to poor image quality in many subjects. Only DFAZ showed statistical difference with a p-value 0.006 between the right and left eye in the age group 5-10 years. Though, individual values of right and left eye were taken, the comparison p-values were adjusted for cluster effect to tackle the association between the eyes from same individual (Table/Fig 5).

Discussion

This study describes the retinal vasculature parameter and the choroidal thickness in normal Indian paediatric population between 5-15 years. In the present study, significant difference between subject below and above 10 years was found only for SFAZ, thus probing the null hypothesis. To the best of our knowledge this was the first Indian study to describe the retinal vasculature calibre in this population. The only Indian study that has looked at the choroidal thickness only. Retinal imaging can document finer changes in retinal vessel diameters which can aid in early diagnosis. Arterial thinning due to chronicity is the initial change documented in hypertension (19). Though, retinal vessel diameter variations are evident clinically, imaging can document these for future follow-up to monitor progression. Cheung N et al., have reported the retinal vessel diameter in children. It is reported as 156.4 μm and 225.4 μm (12).

The values are comparable to present study (Table/Fig 1). Any ocular or systemic factors which could alter the retinal vascular parameters or choroidal thickness like AXL >25 mm or <20 mm, high myopia (>-6 D), hyperopia (>+4 D), systemic hypertension, diabetes, renal disease, low birth weight, BMI >25 kg/m2 and syndrome disorders were excluded.

The choroid is a highly vascular structure, the thickness of which gets affected in various ocular and systemic conditions. These changes in thickness are seen in ocular conditions such as central serous chorioretinopathy, polypoidal choroidal vasculopathy, Vogt- Koyanagi-Harada disease, high myopia, uveitis, age related macular degeneration and systemic conditions such as diabetes mellitus and hypertension (11). With increasing prevalence of children with systemic vascular conditions like hypertension and diabetes, a regular follow-up and screening of choroidal parameters can be of benefit to compare with the baseline values.

Park KA and Oh SY reported on choroidal thickness in normal children and the values are 348.4±82.5 μm which was highly comparable with present study results 343.89±89.99 μm. Significant choroidal thinning have been reported in children with beta thalassaemia major and type 1 diabetes mellitus without retinopathy (13),(20),(21).

Alteration in shape and size of FAZ has been reported in adults in conditions like diabetes, and glaucoma (22). A baseline FAZ and VD around it are vascular parameters that can be used to monitor children with these systemic conditions. Yilmaz I et al., reported on FAZ in norma lchildren and the values of superficial FAZ area was 280 μm2 as compared to present study result 240.83±144.96 (17). They also reported the area of deep FAZ in normal children as 329 μm2 while present study result showed that deep FAZ was 249.37±151.55 μm2. The deep FAZ was wider compared to superficial FAZ and the difference was statistically significant in the present study. Studies on perifoveal and peripapillary vascular density are lacking in normal population among children.

Limitation(s)

The main limitation of this study was that children below 5 years of age were not included. Hence, further studies with larger sample size including children of all age groups are needed to establish the normogram for caliber of retinal vessels and choroidal thickness.

Conclusion

Knowing normal retinal vasculature and choroidal parameters will help in establishing normograms in the Indian paediatric age group between 5-15 years. This will help in screening and monitoring children with systemic vascular diseases. OCT and OCT-A are non invasive techniques for evaluation of retina and choroid which will help in early diagnosis of a disease and follow-up on the effect of treatment resulting in better outcomes and quality of life.

Acknowledgement

Special thanks to Mr. John for capturing and editing OCT images.

References

1.
Kashani AH, Chen CL, Gahm JK, Zheng F, Richter GM, Rosenfeld PJ, et al. Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications. Prog Retin Eye Res. 2017;60:66-100. [crossref] [PubMed]
2.
Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, et al. Optical coherence tomography. Science. 1991;254(5035):1178-81. [crossref] [PubMed]
3.
Wong TY, Shankar A, Klein R, Klein BE, Hubbard LD. Retinal arteriolar narrowing, hypertension, and subsequent risk of diabetes mellitus. Arch Intern Med. 2005;165(9):1060-65. [crossref] [PubMed]
4.
Wong TY, Shankar A, Klein R, Klein BE, Hubbard LD. Prospective cohort study of retinal vessel diameters and risk of hypertension. BMJ. 2004;329(7457):79. [crossref] [PubMed]
5.
Esmaeelpour M, Považay B, Hermann B, Hofer B, Kajic V, Hale SL, et al. Mapping choroidal and retinal thickness variation in type 2 diabetes using three-dimensional 1060-nm optical coherence tomography. Invest Ophthalmol Vis Sci. 2011;52(8):5311-16. [crossref] [PubMed]
6.
Li LJ, Ikram MK, Wong TY. Retinal vascular imaging in early life: Insights into processes and risk of cardiovascular disease. J Physiol. 2016;594(8):2175-03. [crossref] [PubMed]
7.
Cheung CY, Ikram MK, Sabanayagam C, Wong TY. Retinal microvasculature as a model to study the manifestations of hypertension. Hypertension. 2012;60(5):1094-03. [crossref] [PubMed]
8.
Li LJ, Cheung CY, Liu Y, Chia A, Selvaraj P, Lin XY, et al. Influence of blood pressure on retinal vascular caliber in young children. Ophthalmology. 2011;118(7):1459-65. [crossref] [PubMed]
9.
Ikram MK, Witteman JC, Vingerling JR, Breteler MM, Hofman A, de Jong PT. Retinal vessel diameters and risk of hypertension: The Rotterdam study. Hypertension. 2006;47(2):189-94. [crossref] [PubMed]
10.
Wong TY, Klein R, Klein BE, Meuer SM, Hubbard LD. Retinal vessel diameters and their associations with age and blood pressure. Invest Ophthalmol Vis Sci. 2003;44(11):4644-50. [crossref] [PubMed]
11.
Singh SR, Vupparaboina KK, Goud A, Dansingani KK, Chhablani J. Choroidal imaging biomarkers. Surv Ophthalmol. 2019:64(3):312-33. [crossref] [PubMed]
12.
Cheung N, Islam FM, Saw SM, Shankar A, de Haseth K, Mitchell P, et al. Distribution and associations of retinal vascular caliber with ethnicity, gender, and birth parameters in young children. Invest Ophthalmol Vis Sci. 2007;48(3):1018-24. [crossref] [PubMed]
13.
Park KA, Oh SY. An optical coherence tomography-based analysis of choroidal morphologic features and choroidal vascular diameter in children and adults. Am J Ophthalmol. 2014;158(4):716-723.e2. [crossref] [PubMed]
14.
Chhablani JK, Deshpande R, Sachdeva V, Vidya S, Rao PS, Panigati A, et al. Choroidal thickness profile in healthy Indian children. Indian J Ophthalmol. 2015;63(6):474-77. [crossref] [PubMed]
15.
Ruiz-Moreno JM, Flores-Moreno I, Lugo F, Ruiz-Medrano J, Montero JA, Akiba M. Macular choroidal thickness in normal pediatric population measured by swept-source optical coherence tomography. Invest Ophthalmol Vis Sci. 2013;54(1):353-59. [crossref] [PubMed]
16.
He X, Jin P, Zou H, Li Q, Jin J, Lu L, et al. Choroidal thickness in healthy Chinese children aged 6 to 12: The Shanghai children eye study. Retina. 2017;37(2):368-75. [crossref] [PubMed]
17.
Yilmaz I, Ocak OB, Yilmaz BS, Inal A, Gokyigit B, Taskapili M. Comparison of quantitative measurement of foveal avascular zone and macular vessel density in eyes of children with amblyopia and healthy controls: An optical coherence tomography angiography study. J AAPOS. 2017;21(3):224-28. [crossref] [PubMed]
18.
Mo S, Phillips E, Krawitz BD, Garg R, Salim S, Geyman LS, et al. Visualisation of radial peripapillary capillaries using optical coherence tomography angiography: The effect of image averaging. PLoS One. 20179;12(1):e0169385. [crossref] [PubMed]
19.
Kawasaki R, Cheung N, Wang JJ, Klein R, Klein BE, Cotch MF, et al. Retinal vessel diametersand risk of hypertension: The multiethnic study of atherosclerosis. J Hypertens. 2009;27(12):2386-93. [crossref] [PubMed]
20.
Simsek A, Tekin M, Bilak S, Karadag AS, Konca C, Almis H. Choroidal thickness in children with beta thalassemia major. Optom Vis Sci. 2016;93(6):600-06. [crossref] [PubMed]
21.
Öztürk H, Özen B, Manyas H, Çatli G, Dündar B. Can ocular changes be detected early in children and adolescents with type 1 diabetes mellitus without retinopathy by using optical biometry and optical coherence tomography? Int Ophthalmol. 2020;40(10):2503-14. [crossref] [PubMed]
22.
Chen HS, Liu CH, Wu WC, Tseng HJ, Lee YS. Optical coherence tomography angiography of the superficial microvasculature in the macular and peripapillary areas in glaucomatous and healthy eyes. Invest Ophthalmol Vis Sci. 2017;58(9):3637-45. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/56707.16693

Date of Submission: Apr 05, 2022
Date of Peer Review: May 03, 2022
Date of Acceptance: Jul 13, 2022
Date of Publishing: Aug 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 12, 2022
• Manual Googling: Jun 30, 2022
• iThenticate Software: July 11, 2022 (8%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com