Abstract
OCT angiography is a functional extension of OCT that allows for non-invasive imaging of retinal microvasculature. However, most current OCT angiography systems are tabletop systems that are typically used for imaging compliant, seated subjects. These systems cannot be readily applied for imaging important patient populations such as bedridden patients, patients undergoing surgery in the operating room, young children in the clinic, and infants in the intensive care nursery. In this manuscript, we describe the design and development of a non-contact, handheld probe optimized for OCT angiography that features a novel diverging light on the scanner optical design that provides improved optical performance over traditional OCT scanner designs. Unlike most handheld OCT probes, which are designed to be held by the side of the case or by a handle, the new probe was optimized for ergonomics of supine imaging where imagers prefer to hold the probe by the lens tube. The probe's design also includes an adjustable brace that gives the operator a point of contact closer to the center of mass of the probe, reducing the moment of inertia around the operator's fingers, facilitating stabilization, and reducing operator fatigue. The probe supports high-speed imaging using a 200 kHz swept source OCT engine, has a motorized stage that provides + 10 to -10 D refractive error correction and weighs 700g. We present initial handheld OCT angiography images from healthy adult volunteers, young children during exams under anesthesia, and non-sedated infants in the intensive care nursery. To the best of our knowledge, this represents the first reported use of handheld OCT angiography in non-sedated infants, and the first handheld OCT angiography images which show the clear delineation of key features of the retinal capillary complex including the foveal avascular zone, peripapillary vasculature, the superficial vascular complex, and the deep vascular complex.
Highlights
Optical coherence tomography (OCT) is a non-invasive imaging modality that enables in vivo cross-sectional structural imaging of living biological tissues with micron scale resolution [1,2]
To the best of our knowledge the images reported in this manuscript are the first HH-OCT angiography (OCTA) taken of non-sedated infants and the first handheld OCTA (HH-OCTA) which show clear delineation of key features of the retinal capillary complex including the foveal avascular zone (FAZ), peripapillary vasculature, the superficial vascular complex (SVC), and the deep vascular complex (DVC)
While features such as preretinal neovascular elevations are visible in crosssectional imaging, the 3D context provided by volumetric imaging allows for enhanced visualization of 3D structures such as cystoid macular edema (CME), large superficial retinal vasculature, the extent of preretinal neovascular tissues, and structural changes at the vascular/avascular junction in infants with retinopathy or prematurity (ROP)
Summary
Optical coherence tomography (OCT) is a non-invasive imaging modality that enables in vivo cross-sectional structural imaging of living biological tissues with micron scale resolution [1,2]. Due to these characteristics, OCT has become the clinical standard of care for diagnosis and monitoring of adult retinal diseases [3]. Most OCT systems are tabletop systems which require a compliant, seated subject These systems are difficult if not impossible to use on noncompliant or supine subjects such as bedridden patients, patients undergoing surgery in the operating room, young children, and infants. While longitudinal bedside imaging in the intensive care nursey (ICN) can provide valuable diagnostic information about the progression of the disease state, the constraints of the ICN environment such as space-restricted neonatal incubators further motivates the use of compact handheld probes
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