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Tran-Viet, Du, BS*; Wong, Brittany M.*; Mangalesh, Shwetha, MBBS*; Maldonado, Ramiro, MD*; Cotten, C. Michael, MD, MHS; Toth, Cynthia A., MD*,‡

doi: 10.1097/IAE.0000000000001735
Original Study

Purpose: The authors investigated feasibility of undilated handheld spectral domain optical coherence tomography (SDOCT) retinal imaging in preterm infants and children with neurologic abnormalities.

Methods: Under an institutional review board–approved protocol, the authors attempted handheld SDOCT imaging of the retina, choroid, and optic nerve in infants and young children without pupil dilation. Scans were analyzed for quality and successful capture of foveal, optic nerve, and retinal structural parameters and abnormalities.

Results: The authors obtained images through an undilated pupil of 11 infants/children over 28 eye imaging sessions, 27 at the bedside without sedation, and one under anesthesia. Infants had retinopathy of prematurity (n = 8), hypoxic ischemic encephalopathy (n = 2), or obstructive hydrocephalus (n = 1 child). Pupil sizes ranged from 1.0 mm to 3.5 mm. The authors captured fovea and optic nerve scans in 25/28 eye imaging sessions, with scans of adequate quality to discern prespecified foveal and optic nerve morphology, and of the 25 sessions, the choroidal–scleral junction was visible in all but 6 sessions.

Conclusion: Undilated, handheld SDOCT imaging is a potential alternative method to evaluate the retina and optic nerve in patients with relative contraindication to pharmacological pupil dilation. This approach will enable the study of the eye–brain connection and ocular manifestations of neurologic diseases.

The authors demonstrate the feasibility of imaging infants and young children with neurologic abnormality using handheld spectral domain optical coherence tomography without dilation, by evaluating image quality and resolution of foveal and optic nerve characteristics. This approach will allow for better understanding of the eye–brain connection and disease manifestation of brain injury in the retinal layers.

Departments of *Ophthalmology, and

Neonatology, Duke University School of Medicine, Durham, North Carolina; and

Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.

Reprint requests: Cynthia A. Toth, MD, Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710; e-mail:

The Hartwell Foundation; The Andrew Family Charitable Foundation; Research to Prevent Blindness; Retina Research Foundation; NIH Grants: 1UL1RR024128, NIH Roadmap for Medical Research, 1UL1TR001117, National Center for Advancing Translational Sciences, R01 EY025009, Center Core Grant for Vision Research, P30 EY005722.

Paper presented in part at Association for Research in Vision and Ophthalmology, Seattle, WA, May 6, 2013.

C. A. Toth receives royalties through her university from Alcon. She also has unlicensed patents pending in OCT imaging and analysis. The remaining authors have no conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.