Remote retinal imaging of patients from the ER using robotically aligned OCT

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)

 

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