Handheld optical coherence tomography angiography and ultra-wide-field optical coherence tomography in retinopathy of prematurity

IMPORTANCE: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Optical coherence tomography (OCT) has improved the care of adults with vitreoretinal disease, and OCT angiography (OCTA) is demonstrating promise as a technique to visualize the retinal vasculature with lower risk and cost than fluorescein angiography. However, to date, there are no commercially available devices able to obtain ultra-wide-field OCT or OCTA images in neonates. OBJECTIVE: To obtain ultra-wide-field OCT and OCTA images in neonates with ROP using a prototype handheld OCT and OCTA device. DESIGN, SETTING, AND PARTICIPANTS: This observational case series was conducted from March 1 to April 1, 2017, in an academic medical center among 4 neonates with ROP in the neonatal intensive care unit and in the operating room. MAIN OUTCOMES AND MEASURES: Acquisition of wide-field OCT and OCTA images using a handheld prototype OCTA and ultra-wide-field OCT device. RESULTS: Images were obtained from 4 neonates (1 girl and 3 boys; mean age, 38 weeks’ postmenstrual age [range, 34-43 weeks]) with various stages of ROP: 3 in the neonatal intensive care unit and 1 in the operating room. The system can obtain noncontact en face OCT images and horizontal line scans with an approximately 40° field of view and up to 100° (ultra-wide-field) using a contact lens-based approach in a single 2-second scan. In addition, 20° × 20° (approximately 4 × 4-mm) OCTA scans were obtained in patients with ROP in a single 2-second scan. CONCLUSIONS AND RELEVANCE: Optical coherence tomography and OCTA are gaining popularity in pediatric retinal imaging. This study reports on OCTA and ultra-wide-field OCT images in 4 neonates with various stages of ROP that were obtained using a prototype handheld device. Additional studies will be needed to prove the clinical value of this technology.