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A. W. Scott, S. Farsiu, C. A. Toth; Novel Techniques to Evaluate the Infant Retina With Portable Handheld Spectral Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5044.
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© ARVO (1962-2015); The Authors (2016-present)
Imaging the infant macula with documentation of pathology is often critical with medicolegal implications in cases of shaken baby syndrome. Although spectral domain optical coherence tomography (SDOCT) provides higher resolution images and allows faster data acquisition than time domain OCT, its role for uncooperative subjects such as infants, and especially in imaging sequelae of shaken baby syndrome is unclear. We hypothesized that a customized portable handheld SDOCT system accompanied by novel image processing algorithms could be used to image the infant retina and evaluate the extent and treatment of retinal pathology. We demonstrate this with pathology associated with shaken baby syndrome.
A novel SDOCT system (SDOCT, Bioptigen, Inc. Durham, NC) was optimized for infant imaging. Eyes of infants with a history of shaken baby syndrome were imaged. The reference arm and focus were adjusted for the shorter axial length and smaller globe of the pediatric eye. Robust image processing algorithms were developed to better visualize the 3D scans and to fuse the information of repeated scans, creating high quality images.
The portable, handheld SDOCT proved effective for data acquisition. The rapid data acquisition was critical in decreasing motion artifacts often seen with handheld systems. A chronic macular hole, a lamellar hole, and a double layer of epiretinal membrane were among the pathologic findings diagnosed and documented in the infant eyes with shaken baby syndrome. The SDOCT images provided previously unseen details with regards to the morphology of retinal lesions in these infant eyes. This information was important in considering prognosis and clinical management.
As with adults, the customized SDOCT proved to be an invaluable tool in the differentiation of disease processes or injury in the pediatric population. Ergo, along with RetCam fundus photography, SDOCT imaging systems should be considered for assessment and may guide future clinical management in cases of shaken baby syndrome.
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