Development of Optical Coherence Tomography Systems for Intrasurgical and Pediatric Imaging

Abstract

Optical coherence tomography (OCT) is a non-contact imaging modality that provides micron scale resolution of in-vivo tissue. Due to these characteristics, OCT is the clinical standard of care in ophthalmology for the diagnosis and monitoring of ocular diseases. Despite its success in adult clinical ophthalmology, OCT has seen more limited use in other ophthalmic specialties including pediatrics and surgery. This is primarily due to the fact that most commercially available OCT systems are large, tabletop systems that require a compliant seated subject. This limits their utility in imaging non-cooperative, supine subjects such as patients undergoing surgery and infants in the nursery. The works presented in this dissertation describe the development and translation of several OCT systems specialized for intrasurgical and pediatric imaging. The first system presented is a microscope integrated OCT system that provided, for the first time, ever live 4D (3D over time) imaging of retinal microsurgery. We present techniques for visualization of real-time intrasurgical OCT data (chapter 2) and summary imaging results from mock surgeries in the wet lab and over 150 surgeries in the human ophthalmic operating room (chapter 3). For pediatric imaging we present two novel handheld OCT systems for point of care imaging of infants in the nursery. The first is the lightest handheld OCT system ever reported. We show imaging results from the intensive care nursery that demonstrate the ability of this system to image pediatric pathology and retinal development (chapter 5). The second system is faster handheld OCT probe that features a novel optical and ergonomic design (chapter 6). We present initial results from the translation of this system into the nursery. OCT angiography (OCTA) is an emerging functional extension of OCT that leverages the high speed of modern OCT systems to allow for non-invasive imaging of the retinal microvasculature. The final aim of this dissertation reports on the use of the microscope integrated OCT system and the high speed handheld OCT system for OCTA (chapters 4 and 6 respectively). To the best of knowledge the handheld OCTA images described in this manuscript are the first handheld OCTA images taken of an awake infant.