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.