Abstract
Purpose :
Optical coherence tomography (OCT) is the standard of care for monitoring retinal and optic nerve disease. Unfortunately, it is not generally available to critically ill or unconscious patients as conventional OCT requires a co-operative patient to be sat upright and fixating on a target. The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering) is a novel OCT unit with an extendable arm, designed to enable ocular OCT assessment in less mobile patients, including those who are bedbound.
Methods :
We undertook a prospective evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking ocular OCT images in unconscious and critically ill patients. The primary outcome was the feasibility of acquiring clinically-interpretable OCT scans on a consecutive series of patients, matched against a standard protocol. The standard scanning protocol included four scans: standard macula-focused OCT, OCT retinal nerve fibre layer (RNFL), OCT angiography (OCTA) of the macula, and OCTA of the optic nerve head (ONH).
Results :
Feasibility was tested in 14 patients with varying systemic diseasess (including sepsis, traumatic brain injury and toxic epidermal necrolysis). The success rate of each scan was: OCT macula (84% successful), OCT RNFL (76%), OCTA macula (56%) and OCTA ONH (36%). Several operator adjustments significantly improved ease of acquisition and image quality, including multiple operators, reclined or supine positioning, pupil dilation and lubricating eye drops.
Conclusions :
This prospective evaluation indicates the feasibility and potential clinical value of the SPECTRALIS FLEX module in critically ill patients. Portable OCT systems have the potential to bring objective instrument-based ophthalmic assessment to systemically unwell patients, enabling detection and monitoring of ocular complications which may be sight-threatening or be indicators of systemic health status.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.