Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study.

Liu, Xiaoxuan and Kale, Aditya Uday and Capewell, Nicholas and Talbot, Nicholas and Ahmed, Sumiya and Keane, Pearse A and Mollan, Susan and Belli, Antonio and Blanch, Richard J and Veenith, Tonny and Denniston, Alastair K (2019) Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study. BMJ open, 9 (11). e030882. ISSN 2044-6055. This article is available to all UHB staff and students via ASK Discovery tool http:/tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

OBJECTIVE

This study aims to evaluate the feasibility of retinal imaging in critical care using a novel mobile optical coherence tomography (OCT) device. The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering, Heidelberg, Germany) is an OCT unit with a boom arm, enabling ocular OCT assessment in less mobile patients.

DESIGN

We undertook an evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking ocular OCT images in unconscious and critically ill patients.

SETTING

This study was conducted in the critical care unit of a large tertiary referral unit in the United Kingdom.

PARTICIPANTS

13 systemically unwell patients admitted to the critical care unit were purposively sampled to enable evaluation in patients with a range of clinical states.

OUTCOME MEASURES

The primary outcome was the feasibility of acquiring clinically interpretable OCT scans on a consecutive series of patients. The standardised scanning protocol included macula-focused OCT, OCT optic nerve head (ONH), OCT angiography (OCTA) of the macula and ONH OCTA.

RESULTS

OCT images from 13 patients were attempted. The success rates of each scan type are 84% for OCT macula, 76% for OCT ONH, 56% for OCTA macula and 36% for OCTA ONH. The overall mean success rate of scans per patient was 64% (95% CI 46% to 81%). Clinicians reported clinical value in 100% scans which were successfully obtained, including both ruling in and ruling out relevant ocular complications such as corneal thinning, macular oedema and optic disc swelling. The most common causes of failure to achieve clinically interpretable scans were inadequately sustained OCT alignment in delirious patients and a compromised ocular surface due to corneal exposure.

CONCLUSIONS

This prospective evaluation indicates the feasibility and potential clinical value of the SPECTRALIS FLEX OCT system on the critical care unit. Portable OCT systems have the potential to bring instrument-based ophthalmic assessment to critically ill patients, enabling detection and micron-level monitoring of ocular complications.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http:/tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WB Practice of medicine
WN Medical imaging. Radiology
WW Eyes. Ophthalmology
Divisions: Ambulatory Care > Ophthalmology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 15 Nov 2019 14:49
Last Modified: 12 Dec 2019 13:10
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2595

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