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Observational Study
. 2022 Jul 1;140(7):725-729.
doi: 10.1001/jamaophthalmol.2022.1344.

Integrated Visualization Highlighting Retinal Changes in Retinopathy of Prematurity From 3-Dimensional Optical Coherence Tomography Data

Shwetha Mangalesh  1 , Kai R Seely  1 , Du Tran-Viet  1 , Vincent Tai  1 , Xi Chen  1 , S Grace Prakalapakorn  1   2 , Sharon F Freedman  1   2 , Cynthia A Toth  1   3 ; BabySTEPS Group
Collaborators, Affiliations
Observational Study

Integrated Visualization Highlighting Retinal Changes in Retinopathy of Prematurity From 3-Dimensional Optical Coherence Tomography Data

Shwetha Mangalesh et al. JAMA Ophthalmol. .

Abstract

Importance: Early diagnosis of plus disease is critical in the management of retinopathy of prematurity (ROP). However, there is substantial interexpert disagreement in the diagnosis of plus disease based on vascular changes alone. Information derived from optical coherence tomography (OCT) may help characterize the severity of vascular and structural abnormalities in ROP.

Objective: To describe integrated visualization of 3-dimensional (3-D) data from investigational swept-source OCT optimized to delineate retinal vascular and microanatomical features in eyes with and without ROP.

Design, setting, and participants: This cross-sectional, observational report of OCT was captured in the prospective Study of Eye Imaging in Preterm Infants (BabySTEPS) designed in July 2016 at the Duke Health Intensive Care Nursery. Between December 2018 and August 2019, 2 preterm infants born at 24 and 30 weeks' gestation were enrolled, underwent ROP screening, and were imaged at those screening visits. Data at 36 weeks' postmenstrual age were analyzed via this visualization developed between September 2020 and May 2021.

Main outcomes and measures: Superimposed en face retinal vascular shadow view (RVSV) montages and thickness maps were used along with OCT B-scans to evaluate retinal vasculature and cross-section in eyes with and without ROP.

Results: In the right eyes of 2 infants, 3-D data were integrated and visualized from investigational bedside OCT imaging at the posterior pole. In the infant who developed type 1 ROP, RVSV-OCT confirmed presence of dilated and tortuous posterior pole vessels, shunting, and incomplete perifoveal vascular development, resulting in a temporal notch of avascular retina in zone 1. The thickness map revealed irregular pockets of thickening and thinning, and integrated visualization outlined the demarcation between thicker vascularized retina and thinner avascular fovea and presence of extraretinal neovascularization overlying elevated vessels in the superior arcades. In the infant without ROP (stage 0), RVSV-OCT revealed no abnormal vascular findings at the posterior pole. The integrated visualization showed a dome-shaped retinal thickening at the fovea, which was confirmed as macular edema.

Conclusions and relevance: In 2 preterm infants in BabySTEPS, 3-D visualization of OCT findings during the ongoing ROP disease process demonstrated supplemental information about the retinal vasculature and microanatomy that can be useful to clinicians. These additional details provided by OCT could be integrated into future ROP screening methods with artificial intelligence-based analytics.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr Seely reported grants from VitreoRetinal Surgery Foundation outside the submitted work and a patent pending for relevant technologies. Dr Chen reported grants from the National Eye Institute (NEI) and Research to Prevent Blindness during the conduct of the study. Dr Prakalapakorn reported grants from the National Institutes of Health (NIH, R01 EY025009) during the conduct of the study. Dr Toth reported grants from NIH during the conduct of the study, royalties from Alcon and owner equity in Theia Imaging outside the submitted work, and unlicensed and pending patents for OCT imaging through her institution. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Information Extracted From Bedside Optical Coherence Tomography (OCT) Performed at 36 Weeks’ Postmenstrual Age on 2 Preterm Infants Born at 24 and 30 Weeks
Infant 1 (A and B) developed type 1 (treatment-indicated) retinopathy of prematurity (ROP). A, OCT images showed dilated and tortuous posterior pole vessels with shunting (white arrowhead) and the vascular-avascular junction in zone 1 (black arrowheads) on the retinal vessel shadow view (RVSV-OCT). B, Images showed an avascular retina, indicated by the demarcation between the thicker vascularized retina and the thinner avascular fovea, pockets of diffuse retinal thinning, and the presence of extraretinal neovascular tissue overlying the elevated vessels in the superior arcade (black arrowhead) on the retinal thickness maps (inset) superimposed on RVSV-OCT. OCT images from infant 2 (C and D) without ROP showed a dome-shaped retinal thickening representing macular edema and no abnormal vascular findings on the thickness map (inset) superimposed on RVSV-OCT. En face RVSV-OCT images were extracted from data bracketed around the retinal pigment epithelium (A and C). The green (superior arcade) and yellow (foveal) lines indicate the location of the B-scans and the asterisks the location of the fovea (A and C). The color scale for the retinal thickness map is the same in B and D (insets); however, the transparency of the thickness map was increased in D to optimize visualization in print when superimposed on as in D.
Figure 2.
Figure 2.. Optical Coherence Tomography B-Scans in the Fovea and Superior Arcade of the Eyes of 2 Preterm Infants Born at 24 and 30 Weeks
B-scans from infant 1 showed a thin, underdeveloped fovea (A), elevation of superior arcade vessel (white arrowhead) between 2 neovascular buds, and the presence of more extensive extraretinal neovascularization (black arrowhead) (B). B-scans from infant 2 showed cystoid spaces in the inner nuclear layer at the fovea, persistent inner retinal layers (C), and a lack of abnormal findings (ie, elevated vessels or extraretinal neovascularization) across the superior arcade (D). Asterisks indicate the locations of the foveal center.
See this image and copyright information in PMC

References

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