Implementation of optical coherence tomography in retinopathy of prematurity screening

Abstract

Purpose of review: In this review, we explore the investigational applications of optical coherence tomography (OCT) in retinopathy of prematurity (ROP), the insights they have delivered thus far, and key milestones for its integration into the standard of care.

Recent findings: While OCT has been widely integrated into clinical management of common retinal diseases, its use in pediatric contexts has been undermined by limitations in ergonomics, image acquisition time, and field of view. Recently, investigational handheld OCT devices have been reported with advancements including ultra-widefield view, noncontact use, and high-speed image capture permitting real-time en face visualization. These developments are compelling for OCT as a more objective alternative with reduced neonatal stress compared to indirect ophthalmoscopy and/or fundus photography as a means of classifying and monitoring ROP.

Summary: OCT may become a viable modality in management of ROP. Ongoing innovation surrounding handheld devices should aim to optimize patient comfort and image resolution in the retinal periphery. Future clinical investigations may seek to objectively characterize features of peripheral stage and explore novel biomarkers of disease activity.

Figure 1:

Representative ultra-widefield en face ROP fundus images obtained via prototype handheld OCT developed at Oregon Health & Science University [14, 65]. (A) Simultaneous visualization of the posterior pole and ora serrata is possible without scleral depression (yellow arrowheads). (B) Subtle features of stage at the vascular-avascular border are visible in 360 degrees.