Advantages of Widefield Optical Coherence Tomography in the Diagnosis of Retinopathy of Prematurity

Abstract

Recent advances in portable optical coherence tomography (OCT) and OCT angiography (OCTA) have resulted in wider fields of view (FOV) and shorter capture times, further expanding the potential clinical role of OCT technology in the diagnosis and management of retinopathy of prematurity (ROP). Using a prototype, handheld OCT device, retinal imaging was obtained in non-sedated infants in the neonatal intensive care unit (NICU) as well as sedated infants in the operating room of Oregon Health & Science University (OHSU) Hospital. In this observational study, we provide an overview of potential advantages of OCT-based disease assessment in ROP. We observed that next-generation OCT imaging (a) may be sufficient for objective diagnosis and zone/stage/plus disease categorization, (b) allows for minimally-invasive longitudinal monitoring of disease progression and post-treatment course, (c) provides three-dimensional mapping of the vitreoretinal interface, and (d) with OCTA, enables dye-free visualization of normal and pathologic vascular development.

Association of Optical Coherence Tomography–Measured Fibrovascular Ridge Thickness and Clinical Disease Stage in Retinopathy of Prematurity

“…Previous work using an artificial intelligence–based vascular severity score compared with clinical diagnosis has suggested that changes in vascular severity (dilation and tortuosity) are associated with changes in the stage and/or extent of disease. Using OCT to visualize the retinal periphery, it is possible to observe clinical progression of so-called popcorn retinal neovascularization, which occurs posterior to the ridge, as well as the coalescing into the typical stage 3 lesion, the development of retinoschisis and tractional retinal detachment, and the relationship between those features and vascular severity in the posterior retina . In addition, OCT may be useful for monitoring and characterizing patterns of disease regression following both spontaneous resolution of disease and treatment-induced disease regression …”

“…However, recent advances in swept-source handheld OCT devices have been promising . Previous work has provided qualitative evidence that OCT B-scans reveal progressive changes in the retinal topography associated with increasing disease stage …”

“…There are several approaches to visualize the retinal periphery, including the use of scleral depression and optical design changes that improve the FOV at the expense of image resolution . In collaboration with the Center for Ophthalmic Optics and Lasers (COOL) Lab at Oregon Health & University, we recently described a portable ultra-widefield swept-source , and OCT device with a handheld probe that can reliably obtain views of the peripheral stage in ROP .…”

Widefield Optical Coherence Tomography in Pediatric Retina: A Case Series of Intraoperative Applications Using a Prototype Handheld Device

“…Most of the early work using OCT work has focused on macular manifestations of ROP, such as the presence of macular edema, vitreous opacities, and the presence of retinoschisis posterior to the ridge ( 3 , 4 , 30 ). Widefield OCT has demonstrated the potential to provide real-time en face visualization, objective assessment of the peripheral stage, longitudinal monitoring of disease progression and regression, and detection of early vitreoretinal interface abnormalities ( 13 , 14 , 31 ).…”

“…The 105° FOV system has potential to provide objective diagnosis in pediatric retinal diseases with predominantly extramacular pathology, like ROP, and contribute to new insight in these disease processes. We recently described our experience using these devices for ROP screening in the neonatal intensive care unit (NICU) in awake infants ( 13 , 14 ). Here, we present a review of the potential clinical benefits and applications of widefield (WF) and ultra-widefield (UWF) handheld OCT in pediatric retina patients undergoing examinations under anesthesia (EUA) for a variety of conditions.…”