Optical coherence tomography angiography (OCTA) is an extension of OCTA that allows for non-invasive imaging of the retinal microvasculature. OCTA imaging of adult retinal diseases is area of active research in ophthalmology as OCTA can provide insight into the pathogenesis of many retinal diseases. Like these adult diseases, pediatric diseases such as retinopathy of prematurity (ROP) have a primarily vascular pathogenesis. However, table top OCTA systems require compliant, seated subjects and cannot be used on infants and young children. In this manuscript we describe the development of a non-contact handheld OCTA (HH-OCTA) probe for imaging of young children and infants in the operating room. The probe utilizes a novel, diverging light on the scanner optical design that provides improved performance over a traditional OCT scanner design. While most handheld OCT probes are designed to be held by the side of the case or by a handle, our operators tend to prefer to grip probes by the tip of the probe for supine imagine. The ergonomics of the HH-OCTA probe were designed to match this grip. The HH-OCTA probe used a 200 kHz OCT engine, has a motorized stage that provides +10 to -10 D refractive error correction, and weighs 700g. Initial OCTA imaging was performed in 9 children or infants during exam under anesthesia. The HH-OCTA images provide visualization of the retinal microvasculature in both normal and pathological eyes.
OCT is the gold standard for clinical diagnosis and treatment of many retinal diseases. Most clinical OCT systems are table top systems that can only image seated, compliant patients that can fixate. These systems are incapable of imaging several important patient populations including bedridden patients and infants. In this work we describe the use of a custom, light weight, handheld OCT probe based on a high speed swept source engine for imaging in the intensive care nursery. The probe uses custom optics, optomechanics, and a MEMS mirror to achieve a weight of only 211g. The portability and imaging speed of this probe facilitates repeat, volumetric, bedside imaging in a challenging imaging environment. To date we have imaged over 43 pre-term and full-term infants in the intensive care nursery, with some patients having up to 15 imaging sessions starting at 30 weeks post menstrual age. Volumetric OCT enables visualization of the complex 3D structures associated with retinal pathology that is unavailable to slower, B-scan based probes. Repeat imaging shows the development of both normal and diseased retinal structures. We believe that OCT imaging of these infants will reveal retinal abnormalities, enable further study of pediatric retinal diseases, and allow for better management and prediction of future visual outcomes.
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