June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Remote retinal imaging of patients from the ER using robotically aligned OCT
Author Affiliations & Notes
  • Kyung-Min Roh
    Dept of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Ailin Song
    Dept of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Eun Young Choi
    Dept of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Pablo Ortiz
    Dept of Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Shivram Ayyappan Chandramouli
    Dept of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Joseph Izatt
    Dept of Biomedical Engineering, Duke University, Durham, North Carolina, United States
    Dept of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Alexander T. Limkakeng
    Div of Emergency Medicine, Dept of Surgery, Duke University School of Medicine, Durham, North Carolina, United States
  • Ryan P McNabb
    Dept of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Anthony N Kuo
    Dept of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Dept of Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   Kyung-Min Roh, None; Ailin Song, None; Eun Young Choi, None; Pablo Ortiz, None; Shivram Chandramouli, None; Joseph Izatt, Kirkland & Ellis LLP (C), Lecia Microsystems (P), Lecia Microsystems (R), St. Jude Medical (P), St. Jude Medical (R); Alexander Limkakeng, None; Ryan McNabb, None; Anthony Kuo, None
  • Footnotes
    Support  NIH R01-EY029302
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2295. doi:
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    • Get Citation

      Kyung-Min Roh, Ailin Song, Eun Young Choi, Pablo Ortiz, Shivram Ayyappan Chandramouli, Joseph Izatt, Alexander T. Limkakeng, Ryan P McNabb, Anthony N Kuo; Remote retinal imaging of patients from the ER using robotically aligned OCT. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2295.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Significant percentages of emergency room (ER) patients needing an ocular fundus examination do not always receive one by primary providers in the ER. A key reason is the difficulty in using the standard direct ophthalmoscope available in that setting. We have developed and demonstrated the remote application of a robotically aligned OCT (RAOCT) system capable of self-aligning and acquiring high quality volumetric retinal images of subjects from the ER.

Methods : Patients presenting with eye complaints in the ER with ophthalmology referrals were recruited over 7 nonconsecutive days. Hemodynamically unstable patients were excluded.
5 consented subjects under an IRB approved protocol were imaged by the RAOCT system with the operator either 6 feet behind a Plexiglas barrier (2 subj.) or in a separate room remotely connected to the RAOCT system via the local network (3 subj.). Figure 1 shows the layout of the imaging room and the live information transmitted to the operator including 2-way teleconferencing, OCT acquisition, and face/pupil tracking. The RAOCT system used a swept source retinal OCT system (λ0=1043nm; 100 kHz) to capture 32 FOV retinal images including both the fovea and optic nerve head in single acquisitions. Rectangular volumes (700 A-Scans x 250 B-Scans) and full width repeated B-scans (2000 A-scans x 100 B-scans) were taken. The operator confirmed robot-subject alignment and triggered acquisition via a remote terminal session to the RAOCT computer (or directly when non-remote).
Select volumes were semi-automatically segmented and used for thickness maps. Repeatability was described by the standard deviation of repeated retinal thickness measures in the central 1 mm.

Results : Figure 2 shows thickness maps with representative B-scans for non-remotely (2A) and remotely (2B) imaged subjects. The central zone mean range was 294-300 μm with a mean SD of ±1 μm and 260-301 μm with a mean SD of ± 2 μm for non-remotely and remotely imaged subjects respectively.

Conclusions : We have demonstrated remote imaging of ER patients with RAOCT. RAOCT has the potential to help non-specialist personnel evaluate the eye in non-specialty settings with further potential for telemedicine applications.

This is a 2021 ARVO Annual Meeting abstract.

 

Setup of subject-RAOCT positioning (top) and information seen by operator (bottom)

Setup of subject-RAOCT positioning (top) and information seen by operator (bottom)

 

Macular thickness maps with representative B-scans from A) non-remotely (60 y.o. m) and B) remotely (23 y.o. f) imaged subjects

Macular thickness maps with representative B-scans from A) non-remotely (60 y.o. m) and B) remotely (23 y.o. f) imaged subjects

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