Optical Coherence Tomography for Diagnosis and Management of Retinoblastoma

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Key points

  • Portable handheld optical coherence tomography (OCT) has enabled this imaging technique to be applied to the diagnosis and management of retinoblastoma.

  • The high-resolution imaging provided by OCT enables enhanced detection of tumors, including those that are invisible on fundoscopy.

  • OCT has demonstrated the potential to detect recurrences masked by retinal scars.

  • Monitoring treatment effectiveness by OCT provides quantitative values and more objective determinations of disease stability.

  • Future

Diagnostics imaging modalities for retinoblastoma

The gold standard for the diagnosis of retinoblastoma is the fundoscopic examination by indirect ophthalmoscopy. Initially modified by Christian Ruete in 1852 from Hermann von Helmholtz’s direct ophthalmoscope and later refined by Charles Schepens in 1945, indirect ophthalmoscopy provides a large field of vision with the ability to examine the entire retina using scleral depression. Although it enables examination of the complete retina, distinction of retinal elevations are estimated to be

Identification of retinal anatomy and adjacent tumor or seeding

The superior sensitivity of OCT in detecting retinal abnormalities compared with indirect ophthalmoscopy is apparent. Therefore, it is not without reason to conclude that OCT will become critical in the evaluation of retinoblastoma.

The resolution of OCT enables distinguishing differences between normal and pathologic retinal anatomy and to further elucidate the composition and structures of existing lesions. This ability is especially critical in cases where the diagnosis of retinoblastoma is

Identification of small invisible tumors

As a corollary to the utility of OCT in identifying abrupt junctions between normal retinal anatomy and retinoblastoma and tumor seeding is the potential of OCT to detect microscopic or invisible tumors not easily observable on fundoscopy. Variables that can influence the ease of detection include the degree of patient pigmentation, size of the lesions, and anatomic changes secondary to disease progression or involution after treatment. OCT minimizes the influence of these variables, allowing

Screening for recurrence

Vigilance is essential in the management of patients treated for retinoblastoma because retinoblastoma has a penchant for recurrence. In tumors not amenable to control with conservative methods (eg, cryotherapy or laser photocoagulation) treated with chemoreduction and focal consolidation, the rates of retinal, vitreous, and subretinal recurrence at 5 years were 51%, 50%, and 62%, respectively [24]. The risks of metastasis and orbital recurrence in groups D and E eyes that have undergone

Elucidating the cellular origins of tumorigenesis

Although the application of OCT to retinoblastoma has influenced paradigms in clinical diagnosis and management, these same studies have also contributed to the body of knowledge regarding the cellular origin of retinoblastoma and supplement research studies aimed at identifying the specific cell type and genetic milieu that predispose susceptibility to malignant transformation.

One of the earliest clues in identifying the culprit cell can be gleaned from OCT images of small, nascent tumors

Monitoring treatment

Treatment of retinoblastoma is based on disease severity according to the International Intraocular Retinoblastoma Classifcation (IIRC) and uses multimodal approaches for primary disease and recurrences. The goals of treatment are (1) preventing mortality, (2) salvaging the eye, and (3) preserving vision whenever possible. OCT provides another measure by which to gauge the effectiveness of treatments. Experimental models in transgenic mice that develop retinoblastoma have demonstrated that

Relevance to current treatments of retinoblastoma

OCT has the potential to change the diagnosis and management of retinoblastoma just as it revolutionized the landscape in managing other retinal pathologies. With the ability to detect imperceptibly small retinal lesions and fine seeding and to provide objective information on the response to treatment and monitor for recurrences, OCT continues to evolve to be a critical component in retinoblastoma screening and monitoring.

The authors recommend that OCT be used to monitor tumor scars in the

Limitations

With the current state of conventionally available OCT imaging hardware and software, the field of view in OCT imaging is usually limited to approximately 20° from a single acquisition and applies only to tumors in the posterior pole. The peripheral retina, where most new tumors form, is not well imaged with handheld OCT. With manipulation of the globe during imaging, it is possible to acquire areas of interest, such as the fovea, optic nerve, and more peripheral retina; however, the extent of

Future avenues

As advancements in OCT technology continue to develop, there will be potential applications of these breakthroughs to retinoblastoma diagnosis and management.

Already, the spatial resolution of OCT approaches the micron level and, although sufficient for basic practices, efforts to refine the spatial resolution to the submicron level are under way [37]. The details provided on this level could allow for even earlier detection of tumors and treatment.

In addition to improvements in lateral imaging

Summary

OCT is a powerful tool in the diagnosis of retinal disease. Its application to retinoblastoma, however, has been limited given the pediatric population affected and the need for patient cooperation during examination. Furthermore, there has been a lack of a stable platform by which images could be acquired from an anesthetized, supine patient. With a handheld platform, OCT can now be applied to the diagnosis and management of retinoblastoma, allowing for increased sensitivity in detecting

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  • Disclosure statement: The authors have nothing to disclose.

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