Peripheral OCT Assisted by Scleral Depression in Retinopathy of Prematurity

PURPOSE: To determine whether handheld widefield OCT can be used to document retinopathy of prematurity (ROP) stage while using scleral depression to improve peripheral views. DESIGN: Prospective, observational study. PARTICIPANTS: Consecutive neonates admitted to the neonatal intensive care unit in a single academic medical center who also met criteria for ROP screening and whose parents or guardians consented for them to undergo research imaging. METHODS: Scleral depression was combined with widefield OCT using an investigational 400-kHz, 55° field of view, handheld OCT during routine ROP screening from October 28, 2020, through March 3, 2021. MAIN OUTCOME MEASURES: Acquisition of en face and B-scan imaging of the peripheral retina to assess early vitreoretinal pathologic features objectively, including the demarcation between vascularized and anterior avascular retina, the presence of early ridge formation, and small neovascular tufts. RESULTS: Various stages of ROP were detected using a rapid-acquisition OCT system. In 1 neonate, serial OCT imaging over a 5-week period demonstrated accumulation of neovascular tufts with progression to stage 3 ROP with extraretinal fibrovascular proliferation along the ridge. Videography of this technique is included in this report for instructional purposes. CONCLUSIONS: Serial examinations using widefield OCT and scleral depression are feasible and may improve detection and documentation of ROP disease progression. Earlier detection of ROP-related proliferation may prevent vitreoretinal traction, retinal detachment, and blindness.