Using OCT to predict neurodevelopmental risk in preterm infants: Cynthia Toth, MD

Cynthia Toth, MD, of the Duke Department of Ophthalmology, reported that retinal nerve fiber layer and choroidal thickness measured by bedside optical coherence tomography (OCT) in preterm infants correlate with neurodevelopmental outcomes at 2 years of age, offering a potential early window into brain development long before symptoms of impairment appear.

The findings, published in JAMA Ophthalmology, come from BabySTEPS, an NIH-funded prospective study examining eye, brain, and vision development in preterm infants. Toth explained that the work builds on an earlier 2015 study in which her team found that OCT-measured nerve fiber layer thickness and macular edema were associated with neurodevelopmental outcomes in preterm infants who already had known brain injury.¹ That earlier cohort, however, was assembled retrospectively and cross-sectionally. BabySTEPS enrolled infants prospectively, regardless of known brain abnormality, and followed 72 children to age 2. Those with thicker nerve fiber layers and thicker choroids had higher Bayley Scale scores for motor and cognitive development, and nerve fiber layer thickness also correlated with autism risk assessments.

Toth attributed the nerve fiber layer's predictive strength to its direct anatomic link to the brain: retinal ganglion cell axons extend into the lateral geniculate nucleus, making the retina an accessible extension of brain tissue. She noted that OCT is particularly well suited to this population because it is lower-stress than a standard eye exam, provides precise, objective, and repeatable measurements, and can capture retinal changes that parallel the brain's rapid third-trimester development.

Despite the promising signal, Toth cautioned that commercially available handheld OCT devices for pediatric use are not currently on the market, and additional prospective validation is needed before bedside screening could be adopted into routine neonatal intensive care unit protocols. She disclosed being a co-founder of one of two companies developing handheld OCT technology for this purpose.

Looking ahead, Toth said the same biomarkers could help evaluate emerging neurodevelopmental interventions during the neonatal intensive care unit stay and extend BabySTEPS' broader goals around retinopathy of prematurity screening, as well as earlier identification of infants with inherited retinal or systemic diseases.

References

1. Rothman AL, El-Dairi MA, Melton I, et al. Thinner retinal nerve fiber layer in very preterm versus term infants and relationship to brain anatomy and neurodevelopment. Am J Ophthalmol. 2015. Accessed July 7, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC4651865/ — PMC (NIH)