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Brief Report
September 2017

Handheld Optical Coherence Tomography Angiography and Ultra–Wide-Field Optical Coherence Tomography in Retinopathy of Prematurity

Author Affiliations
  • 1Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
  • 2Department of Ophthalmology, University of California–San Diego
  • 3Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary at Chicago
JAMA Ophthalmol. 2017;135(9):977-981. doi:10.1001/jamaophthalmol.2017.2481
Key Points

Question  Is it possible to perform optical coherence tomography angiography in neonates with retinopathy of prematurity using a handheld device?

Finding  In this case series of 4 neonates with retinopathy of prematurity (3 in the neonatal intensive care unit and 1 under anesthesia in the operating room), handheld optical coherence tomography angiography was able to demonstrate retinal and choroidal vascular changes following laser treatment.

Meaning  Handheld optical coherence tomography angiography was able to noninvasively visualize microvascular changes in retinopathy of prematurity, suggesting that future development and clinical validation of this technology in retinopathy of prematurity may be feasible.


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.