HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING THROUGH THE UNDILATED PUPIL IN INFANTS BORN PRETERM OR WITH HYPOXIC INJURY OR HYDROCEPHALUS

Abstract

Purpose: The authors investigated feasibility of undilated handheld spectral domain optical coherence tomography (SDOCT) retinal imaging in preterm infants and children with neurologic abnormalities.

Methods: Under an institutional review board-approved protocol, the authors attempted handheld SDOCT imaging of the retina, choroid, and optic nerve in infants and young children without pupil dilation. Scans were analyzed for quality and successful capture of foveal, optic nerve, and retinal structural parameters and abnormalities.

Results: The authors obtained images through an undilated pupil of 11 infants/children over 28 eye imaging sessions, 27 at the bedside without sedation, and one under anesthesia. Infants had retinopathy of prematurity (n = 8), hypoxic ischemic encephalopathy (n = 2), or obstructive hydrocephalus (n = 1 child). Pupil sizes ranged from 1.0 mm to 3.5 mm. The authors captured fovea and optic nerve scans in 25/28 eye imaging sessions, with scans of adequate quality to discern prespecified foveal and optic nerve morphology, and of the 25 sessions, the choroidal-scleral junction was visible in all but 6 sessions.

Conclusion: Undilated, handheld SDOCT imaging is a potential alternative method to evaluate the retina and optic nerve in patients with relative contraindication to pharmacological pupil dilation. This approach will enable the study of the eye-brain connection and ocular manifestations of neurologic diseases.

Conflict of interest statement

Conflict of Interest: Dr. Toth recieves royalties through her university from Alcon. She also has unlicened patents pending in OCT imaging and analysis. No other authors have financial disclosures. No authors have a proprietary interest in the current study.

Figures

Figure 1

Overview of study population and the ability to image fovea and optic nerve with handheld spectral domain optical coherence tomography imaging on undilated infants and children.

Figure 2

Spectral domain optical coherence tomography (SDOCT) scans on undilated infants at the foveal center. (A) A 35-week postmenstrual age (PMA) infant with Retinopathy of Prematurity (ROP) imaged through a 2mm pupil showing normal foveal contour with persistent inner retinal layers. (B) A 41-week PMA infant diagnosed with severe hypoxic ischemic encephalopathy imaged through a 2.5mm pupil showing subretinal fluid at the fovea.,(C) A 37 week PMA infant with ROP imaged through a 2.5mm pupil showing inner retinal thickening due to macular edema, with cystoid spaces in the inner nuclear layer. In all three foveal images, the photoreceptor layer is immature (consistent with age) with absence of the ellipsoid zone at the foveal center in A and C (white arrows) and a short distance between the thin outer plexiform layer (black arrow) and the retinal pigment epithelium.

Figure 3

Spectral domain optical coherence tomography (SDOCT) three dimensional volumes including the optic nerve (left) from b-scans (right) on undilated infants at the optic nerve. (A) A 35-week postmenstrual age (PMA) infant with Retinopathy of Prematurity (ROP) imaged through a 2mm pupil. The fovea (black arrow) is distinct from optic nerve head (white arrow) and a hyaloidal vessel is extended from the optic nerve head. (B) A 35-week PMA infant diagnosed with hypoxic ischemic encephalopathy imaged through a 3.5mm pupil. The retinal vasculature was visible across the retinal surface (black arrows). (C) A 2-year old child diagnosed with obstructive hydrocephalus imaged through a 1mm pupil revealed the elevated optic nerve head (white arrow). On the B scan, there is pronounced retinal thinning adjacent to the optic nerve and the choroid is thin.