Imagine a world where preventable childhood blindness could be eradicated. That’s the bold vision driving a groundbreaking innovation in pediatric eye care. But here’s where it gets controversial: what if the tools we’ve been using to diagnose a leading cause of childhood blindness are not only outdated but also unnecessarily risky for vulnerable infants? Researchers at the OHSU Casey Eye Institute are challenging this status quo with the world’s first handheld ultra-widefield optical coherence tomography (OCT) system, paired with artificial intelligence, to revolutionize the diagnosis of retinopathy of prematurity (ROP).
ROP, a condition affecting premature infants, is the primary cause of childhood blindness globally. In the U.S. alone, approximately 500 infants lose their sight to ROP annually, while worldwide, the number skyrockets to an estimated 50,000. The tragedy? Much of this vision loss is preventable with early and accurate diagnosis. Yet, despite advancements in adult retinal imaging, pediatric care has lagged behind. And this is the part most people miss: the standard method for diagnosing ROP still involves indirect ophthalmoscopy, a procedure that requires manipulating an infant’s delicate eye with a scleral depressor. This not only causes stress to the baby but can also lead to complications like bradycardia and oxygen desaturation. Worse, the diagnosis is highly subjective, leading to inconsistent treatment decisions.
Enter the OHSU team’s handheld OCT system, a game-changer designed to overcome these challenges. Operating at speeds of 400 to 800 kHz, this device captures ultra-widefield images of awake, non-sedated infants in just one second, with a field of view up to 140 degrees—extending to the ora serrata without the need for a scleral depressor. Dr. J. Peter Campbell, a leading ophthalmologist on the project, explains, ‘The eye exam in babies is incredibly challenging. With traditional methods, you’re piecing together a mental mosaic over several minutes. This system gives us the full picture in a single second.’
The device was built from scratch using custom optical components, including specialized lenses and fibers to minimize light loss, alongside high-speed computational systems for real-time image processing. Dr. Campbell notes that its field of view surpasses even the most advanced adult OCT systems available in the U.S. The development process followed a bench-to-bedside approach, with Dr. Yifan Jian, a biomedical engineer, collaborating closely with clinicians in neonatal intensive care units to refine the hardware based on real-world feedback. ‘Seeing our technology make an immediate impact in the clinic is what fuels our research,’ Dr. Jian said.
Beyond imaging, the system transforms ROP diagnosis from a subjective assessment to a quantitative science. The ultra-widefield OCT provides precise measurements of retinal structures, such as ridge thickness and volume, with permanent documentation. Integrated AI algorithms analyze images in real time, enabling autonomous disease detection—a game-changer for telemedicine screening. ‘Our ultimate goal is to merge the AI with the OCT, so clinicians receive not just a high-quality image but also a severity score that standardizes diagnosis across the board,’ Dr. Campbell explained.
This AI component builds on OHSU’s earlier success with the i-ROP DL deep learning system, which received FDA Breakthrough Device designation in 2020 for diagnosing clinically significant ROP. Both the imaging system and AI technology are currently progressing through FDA approval, with commercial availability expected within the next year via an OHSU startup. The team is also developing a second-generation camera to reduce costs while maintaining performance, paving the way for global deployment.
Orbis International, the largest ophthalmic NGO, has invested in the venture through philanthropic funding, underscoring the urgent need for scalable telemedicine solutions to combat ROP worldwide. ‘Our mission is to place a camera in every NICU globally within the next five to ten years,’ Dr. Campbell stated.
The technology’s applications extend beyond ROP, with adaptations for retinoblastoma screening, uveal melanoma monitoring, and intraoperative surgical guidance. In 2024, Dr. Campbell’s contributions were recognized with an innovation award at a Cleveland Clinic neonatology conference.
OHSU Casey Eye Institute has been at the forefront of ROP research for over four decades, from Dr. Earl Palmer’s pioneering clinical trials to Dr. Michael Chiang’s role in redefining the international classification of ROP. ‘Oregon has consistently punched above its weight in ROP care,’ Dr. Campbell noted. ‘We’re undoubtedly among the top three or four institutions globally in terms of impact.’
Here’s the thought-provoking question: As this technology moves closer to widespread adoption, will it not only transform ROP diagnosis but also spark a broader revolution in pediatric eye care? And how can we ensure equitable access to such life-changing innovations for vulnerable infants worldwide? Share your thoughts in the comments—let’s start a conversation that could shape the future of pediatric vision.
