Impact of fundus pigmentation on retinal layer and choroidal scleral junction visibility on investigational bedside OCT in preterm infants

Abstract

Purpose : Dark fundus pigmentation (FP) can limit fundus photography quality in eyes being evaluated for retinopathy of prematurity. We sought to determine the impact of FP on retinal layer and choroid-scleral junction (CSJ) visibility and scan quality for investigational bedside swept source (SS) optical coherence tomography (OCT) imaging.

Methods : We analyzed investigational SS-OCT images captured between 30-42 weeks post menstrual age in 188 eyes of 94 preterm infants enrolled in BabySTEPS study (NCT02887157). Trained ophthalmologists, masked to OCT findings, determined FP (dark/medium/blond). Expert graders, masked to FP, evaluated OCT images for: 1) age-appropriate retinal layers visible (yes/no), 2) CSJ visible (yes/no), and 3) overall OCT quality (excellent/acceptable/poor/unusable). To assess the association of FP with retinal layer and CSJ visibility and OCT quality, we performed multivariable logistic regression modeling, adjusting for biologic and demographic confounders and correlations from repeated OCT scans and paired eyes.

Results : Mean gestational age was 27.8±2.6 (SD) weeks, mean birthweight was 964±283 grams; 51 (54%) infants were non-white, and 48 (51%) infants were male. FP was dark in 24 (13%) eyes, medium in 92 (49%), and blond in 72 (38%). All age-appropriate retinal layers were visible in 781 of 846 scans (92%), CSJ was visible in 701 (83%), and OCT quality was excellent/acceptable in 725 scans (86%). Compared to eyes with blond FP, eyes with medium and dark FP did not have higher odds of inability to see all age-appropriate retinal layers on OCT (adjusted OR 1.17 [95% CI 0.39-3.51] and 0.57 [95% CI 0.15-2.20], respectively) or poor/unusable OCT scan quality (adjusted OR 0.87 [95% CI 0.50-1.48] and 0.49 [95% CI 0.16-1.55], respectively). Conversely, eyes with medium and dark FP had higher odds of inability to visualize the CSJ (adjusted OR 2.8 [95% CI 1.49-5.31] and 4.8 [95% CI 1.48-15.48], respectively).

Conclusions : Medium and dark FP affected visibility of CSJ but did not affect overall scan quality or age-appropriate retinal layer visibility on investigational bedside OCT in preterm infants. This study supports the feasibility of using OCT to analyze retinal microanatomy in diverse populations of preterm infants with a range of fundus pigmentation. Further imaging methods/system enhancement could be pursued to improve CSJ imaging.

This is a 2021 ARVO Annual Meeting abstract.