Peripheral optical coherence tomography assisted by scleral depression in retinopathy of prematurity

Abstract

Objective: To determine whether handheld widefield optical coherence tomography (OCT) can be used to document retinopathy of prematurity (ROP) stage while using scleral depression to improve peripheral views. Design: Prospective observational study. Participants: Consecutive neonates admitted to the neonatal intensive care unit (NICU) in a single academic medical center who also met criteria for ROP screening and consented for research imaging. Methods: Scleral depression was combined with widefield OCT using an investigational 400-kHz, 55-degree field of view handheld OCT during ROP screening from October 28, 2020 to March 03, 2021. Main Outcome Measures: Acquisition of en face and B-scan imaging of the peripheral retina to objectively assess early vitreoretinal pathology, including the demarcation between vascularized and anterior avascular retina, the presence of early ridge formation, and small neovascular tufts. Results: Various stages of ROP were detected using a rapid acquisition OCT system. In one neonate, serial OCT imaging over a five-week period demonstrated accumulation of neovascular tufts with progression to stage 3 ROP with extraretinal fibrovascular proliferation along the ridge. Videography of this technique is included in this report for instructional purposes. Conclusions: Serial examinations using widefield OCT and scleral depression may improve detection and documentation of ROP disease progression. Earlier detection of ROP-related proliferation may prevent vitreoretinal traction, retinal detachment, and blindness.

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

“…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. [10][11][12] 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. 9…”

“…[5][6][7][8] Previous work has provided qualitative evidence that OCT B-scans reveal progressive changes in the retinal topography associated with increasing disease stage. [9][10][11][12] 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. 10,11 In collaboration with the Center for Ophthalmic Optics and Lasers (COOL) Lab at Oregon Health & University, we recently described a portable ultra-widefield sweptsource , and OCT device with a handheld probe 13,14 that can reliably obtain views of the peripheral stage in ROP.…”

“…[9][10][11][12] 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. 10,11 In collaboration with the Center for Ophthalmic Optics and Lasers (COOL) Lab at Oregon Health & University, we recently described a portable ultra-widefield sweptsource , and OCT device with a handheld probe 13,14 that can reliably obtain views of the peripheral stage in ROP. [15][16][17] In this article, we evaluate whether the retinal thickness as measured on B-scans at the vascular-avascular junction may provide a quantifiable biomarker of ROP stage.…”

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

“…We previously described a widefield, handheld SS-OCT device with a >55° FOV, that was capable of visualizing peripheral pathology when coupled with scleral depression ( 15 ). Subsequently, we have re-engineered the FOV to approximately 105° in a new design, which can provide real-time en face visualization that can be used to optimize the image quality and orientation prior to image acquisition, which takes 1.5 s. ( 16 ) Our experience operating this device in the NICU has provided a number of observations as to how advances in OCT technology may provide value to patient care in the future.…”