Ultra-widefield optical coherence tomography in retinopathy of prematurity

Abstract

Purpose : Optical coherence tomography (OCT) has the potential to provide objective diagnosis of ROP, however, integration of OCT into ROP diagnosis has been limited. We investigate whether an investigational 140 degree field of view OCT has the potential to assist with ROP diagnosis in awake neonates.

Methods : We review our experience imaging 35 unique patients, more than 100 imaging sessions, in the neonatal intensive care unit (NICU) who met criteria for ROP screening (birthweight ≤ 1500g or gestational age ≤ 30 weeks). Patients underwent ophthalmoscopic exam and OCT imaging using a 400-kHz, portable, contact swept-source system with a real-time feedback display, following placement of an eyelid speculum and pharmacological dilation. RetCam imaging was performed in some cases for comparison. Experience with OCT-based diagnosis versus ophthalmoscopic diagnosis was qualitatively compared by a single, unmasked examiner.

Results : The full ICROP classification could be made in all imaging sessions unless research imaging was deferred for medical reasons. The field of view of the contact-based design appeared wider than Retcam 130 degree lens (Figure 1). In addition to documentation of the extent of peripheral stage, in some cases, it was possible to visualize the ora serrate and document full vascularization of the retina (Figure 2). Anecdotally, it was easier to visualize the peripheral stage through small pupils compared to ophthalmoscopy, and while not formally measured, the exam seemed to be faster and better tolerated by the babies.

Conclusions : Early experience with an investigational contact-based UWF-OCT suggests that OCT-based screening may provide objective documentation and diagnosis of the full spectrum of Zone, Stage, and Plus disease in ROP. Although not formally studied here, our experience suggests that OCT-based screening also has the potential to be faster, less stressful to the neonate (and preferred by NICU nurses) compared to the ophthalmoscopic examination or standard fundus imaging.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.