VISION 2019

Optical coherence tomography angiography (OCT-A) is an exciting new technology that allows ophthalmologists to capture more detailed images of the back of the eye than ever before. OCT-A takes the traditional OCT technology, which has been used for decades, and speeds it up to the point where we can actually map and measure blood flow through the vasculature in the retina and view the images from different angles and layers. One of the major challenges with OCT-A, like most other forms of imaging, is that the patient must sit still for at least a minute. That’s fine for adult patients or older adolescents, notes Duke adult and pediatric vitreoretinal surgeon Lejla Vajzovic, MD, “but you can’t ask a three-year-old or an infant to put her head in a chin rest and stay still!” Vajzovic and her colleagues, Cynthia Toth,MD; Xi Chen, MD; Sharon Freedman, MD; and Mays El-Dairi, MD at the Duke Pediatric Retina and Optic Nerve Center (DPROC) and Duke Medical School student S. Tammy Hsu, BA are looking for ways to use this valuable technology with children who are too young to sit still. DPROC is partnering with Heidelberg Engineering to test a portable device with an armature that can be swung over the patient to take OCT-A images while the child is already under anesthesia for an exam or procedure. Through this clinical research, which is being conducted under an IRB-approved protocol, Duke Eye Center will help optimize the technology so it can be submitted for FDA approval. The DPROC team is the first to publish on use of OCT-A in newborns and young children. They have already published a series of journal articles to explain to peers how to use the OCT-A technology with young patients and for various diseases.“ Another advantage of OCT-A, particularly in young children, is that it is noninvasive,” Vajzovic explains. “Fluorescein angiography, which has been used for decades to capture images of the blood vessels in the back of the eye, requires injecting a dye into the patient’s body, so you have a needle stick and a small risk of serious anaphylactic reaction to the dye. “With OCT-A, we can

eliminate the needle stick and the risk of anaphylactic reaction,” she says. “And eventually, as we develop this technology, we’ll hopefully be able to use it with kids in the clinic, eliminating the need to anesthetize children, which carries its own risks. That would be a huge step forward in the care of our youngest patients.” When They Simply Can’t Sit Still Duke Team Adapts Newest Retinal Imaging Technology to Address the Unique Needs of Infants and Children “You can’t ask a three-year-old or an infant to put her head in a chin rest and stay still!“ Lejla Vajzovic, MD S. Tammy Hsu, BA