Vitreoretinal biomarkers of retinopathy of prematurity using handheld optical coherence tomography: a review

The Perspective of Using Optical Coherence Tomography in Ophthalmology: Present and Future Applications

Optical coherence tomography (OCT) imaging plays a major role in the field of diagnosing, monitoring, and treating ophthalmological diseases. Since its introduction in the early 1990s, OCT technology has continued to advance both in the direction of acquisition quality and technique. In this manuscript, we concentrate on actual and future applications of OCT in the ophthalmology field, reviewing multiple types of OCT techniques and systems, such as visible-light OCT, adaptative optics OCT, intraoperative OCT, wide-field OCT, and more. All of them allow better monitoring of ocular diseases, earlier and broader diagnosis, and a more suitable treatment. Furthermore, overviewing all these technologies could play a pivotal role in research, leading to an advance in understanding the pathophysiology of targeted diseases. Finally, the aim of the present review was to evaluate the technical advances in OCT and their actual and potential clinical applications.

Assessing spectral effectiveness in color fundus photography for deep learning classification of retinopathy of prematurity

Significance

Retinopathy of prematurity (ROP) poses a significant global threat to childhood vision, necessitating effective screening strategies. This study addresses the impact of color channels in fundus imaging on ROP diagnosis, emphasizing the efficacy and safety of utilizing longer wavelengths, such as red or green for enhanced depth information and improved diagnostic capabilities.

Aim

This study aims to assess the spectral effectiveness in color fundus photography for the deep learning classification of ROP.

Approach

A convolutional neural network end-to-end classifier was utilized for deep learning classification of normal, stage 1, stage 2, and stage 3 ROP fundus images. The classification performances with individual-color-channel inputs, i.e., red, green, and blue, and multi-color-channel fusion architectures, including early-fusion, intermediate-fusion, and late-fusion, were quantitatively compared.

Results

For individual-color-channel inputs, similar performance was observed for green channel (88.00% accuracy, 76.00% sensitivity, and 92.00% specificity) and red channel (87.25% accuracy, 74.50% sensitivity, and 91.50% specificity), which is substantially outperforming the blue channel (78.25% accuracy, 56.50% sensitivity, and 85.50% specificity). For multi-color-channel fusion options, the early-fusion and intermediate-fusion architecture showed almost the same performance when compared to the green/red channel input, and they outperformed the late-fusion architecture.

Conclusions

This study reveals that the classification of ROP stages can be effectively achieved using either the green or red image alone. This finding enables the exclusion of blue images, acknowledged for their increased susceptibility to light toxicity.

Implementation of optical coherence tomography in retinopathy of prematurity screening

PURPOSE OF REVIEW

In this review, we explore the investigational applications of optical coherence tomography (OCT) in retinopathy of prematurity (ROP), the insights they have delivered thus far, and key milestones for its integration into the standard of care.

RECENT FINDINGS

While OCT has been widely integrated into clinical management of common retinal diseases, its use in pediatric contexts has been undermined by limitations in ergonomics, image acquisition time, and field of view. Recently, investigational handheld OCT devices have been reported with advancements including ultra-widefield view, noncontact use, and high-speed image capture permitting real-time en face visualization. These developments are compelling for OCT as a more objective alternative with reduced neonatal stress compared to indirect ophthalmoscopy and/or fundus photography as a means of classifying and monitoring ROP.

SUMMARY

OCT may become a viable modality in management of ROP. Ongoing innovation surrounding handheld devices should aim to optimize patient comfort and image resolution in the retinal periphery. Future clinical investigations may seek to objectively characterize features of peripheral stage and explore novel biomarkers of disease activity.

Early Single-Examination Optical Coherence Tomography Biomarkers for Treatment-Requiring Retinopathy of Prematurity

Purpose

Optical coherence tomography (OCT) is an emerging adjunct imaging modality to evaluate retinopathy of prematurity (ROP). From an 11-year research database, we identify early OCT biomarkers that predict treatment-requiring ROP (TR-ROP).

Methods

For preterm infants with acceptable OCT images at 32 ± 1 weeks postmenstrual age (PMA), we extracted the following measures: total retina, inner retinal layer (IRL), and outer retinal layer (ORL) thicknesses at the fovea and the parafovea, inner nuclear layer (INL) and choroidal thickness, parafovea/fovea (P/F) ratio, and presence of macular edema. Using univariable and multivariable logistic regression models, we evaluated the association between retinal and choroidal OCT measurements at 32 ± 1 weeks PMA and development of TR-ROP.

Results

Of 277 eyes (145 infants) with usable OCT images, 67 eyes had TR-ROP. Lower P/F ratio (P < 0.0001), thicker foveal IRL (P = 0.0001), and thinner choroid (P = 0.03) were associated with TR-ROP in univariable analysis, but lost significance of association when adjusted for gestational age and race. Absence of macular edema was associated with TR-ROP when adjusted for gestational age and race (P = 0.01). In 185 eyes without macular edema, P/F ratio was associated with TR-ROP in both univariable analysis (P < 0.0001) and multivariable analysis (P = 0.02) with adjustment for gestational age and race.

Conclusions

Presence of macular edema at 32 ± 1 weeks PMA in infants with lower gestational age may be protective against TR-ROP. In infants without macular edema, P/F ratio may be an early OCT biomarker for development of TR-ROP. Incorporation of early OCT biomarkers may be useful in prediction of TR-ROP.

Preterm infant retinal OCT markers of perinatal health and retinopathy of prematurity

The increasing survival of preterm infants has led to the importance of improving long-term outcomes associated with preterm birth. Antenatal and perinatal insults not only impact mortality, but also long-term disability. While in the intensive care nursery, preterm infants are also exposed to various stressors that lead to long-term cognitive deficits. It is therefore critical to identify early, low-stress, non-invasive biomarkers for preterm infant health. Optical coherence tomography (OCT) is a powerful imaging modality that has recently been adapted to the infant population and provides noninvasive, high-resolution, cross-sectional imaging of the infant eye at the bedside with low stress relative to conventional examination. In this review we delve into discussing the associations between preterm systemic health factors and OCT-based retinal findings and their potential contribution to the development of non-invasive biomarkers for infant health and for retinopathy of prematurity (ROP).