High-resolution retinal imaging in young children using a handheld scanner and Fourier-domain optical coherence tomography

Abstract

Purpose: To test the feasibility and applicability of a handheld probe for Fourier-domain optical coherence tomography (Fd-OCT) retinal imaging in infants and children.

Methods: Thirty children ages 7 months to 9.9 years, with (10 of 30) or without (20 of 30) retinal pathology, were imaged with Fd-OCT. Imaging was performed under sedation in 10 of 30 children ages 7 months to 3.7 years. A high-resolution Fd-OCT system (axial resolution: 4.5 mum; acquisition speeds: 1000 A-scans/frame, 9 frames/second), constructed at the UC Davis Medical Center, in conjunction with a handheld scanner, was used for retinal imaging.

Results: Useful images were obtained from all selected patients. Image acquisition was possible in a conscious state in children as young as 3 years of age. All children tolerated the tests well. The most challenging situation for young children was the lack of an internal fixation target and the moving scanning line, which usually distracted them from a steady fixation. Despite these problems, image quality was comparable with scans previously obtained from an adult population.

Conclusions: The flexible handheld scanner in association with high acquisition speed and high-resolution Fd-OCT allows retinal imaging in infants and children. This technology provides high-resolution documentation of retinal structure in a pediatric population for the first time.

FIG 1

Retinal image acquisition. (A) Conscious 5-year-old child, fitted with a chin rest, with scanner mounted on a slit-lamp post. (B) Sedated 2-year-old infant and the handheld scanner.

FIG 2

Fd-OCT horizontal line scans through the macula of control subjects. Subjects were tested sedated (ages 1.26 and 3 years; imaging in supine position) or conscious (age 6.1 years, imaging with chin rest). CL, connecting cilia; GCL, ganglion cell layer; ILM/NFL, internal limiting membrane/nerve fiber layer; INL, inner nuclear layer; IPL, inner plexiform layer; ISL, inner segment layer; ONL, outer nuclear layer; OPL, outer plexiform layer; OSL, outer segment layer; RPE/BM, retinal pigment epithelium/Bruch’s membrane; VM, Verhoeff’s membrane.*Outer limiting membrane.