OCT Diagnoses Shaken Baby Syndrome

Ophthalmologists examining infants for possible shaken baby syndrome (SBS) found that a handheld spectral domain optical coherence tomography (SD-OCT) device provided high-resolution images of the retina and the vitreoretinal interface in infants with SBS, reports a study in the current issue of Retina, The Journal of Retinal and Vitreous Diseases.

According to Thomas C. Lee, MD, director of the Retina Institute in The Vision Center at Childrens Hospital Los Angeles, and one of the study authors, “Traditional imaging is often used in documenting retinal damage in the eyes of children with SBS. However, it does not enable physicians to examine the surface of the retina in great detail. The handheld SD-OCT device enables us to examine the vitreoretinal interface and microarchitecture of the retina. Ophthalmologists can then differentiate the cause of the retinal damage and say with a high degree of confidence that it was caused by repetitive shaking and not a fall or other accident.”

Optical coherence tomography uses near-infrared and other long-wavelength light to penetrate deep inside the eye. This enables a close-up look at tissues not visible to traditional camera technology.

According to the National Center on Shaken Baby Syndrome, some 1,300 infants every year experience severe head trauma from child abuse, and 300 die from it. Under state and federal law, physicians and other medical experts are required to report suspected cases of child abuse to local authorities for possible legal action. Because retinal hemorrhage in the infant is one of the primary symptoms of SBS, ophthalmologists are often called upon to examine infants at risk and document their findings for possible submission to child protection authorities.

Childrens Hospital of Los Angeles (CHLA) admits approximately 50 children per year who are forensically evaluated for suspected child abuse. Sixty percent of these patients, all under the age of two, have injuries sustained from head trauma. Of those, almost half are the result of abusive head trauma compatible with vigorous and violent shaking.

The Vision Center at CHLA is the only facility in the U.S. currently using a handheld SD-OCT to examine infants with eye diseases such as retinopathy of prematurity, retinoblastoma and eye trauma.

The study published in Retina looked at the retinal findings of three consecutive cases of suspected SBS as they presented to the CHLA emergency room. All three patients underwent complete ocular examination, fundus photography with the RetCam and imaging with the handheld SD-OCT device. Of the six eyes examined, the SD-OCT device documented focal posterior vitreous separation in four of the eyes and multilayered retinoschisis in one eye. It also documented preretinal hemorrhages in five eyes. All patients had vitreoretinal abnormalities not detected on clinical examination (e.g., multilayered retinoschisis).

The Retina article, “Handheld Spectral Domain-Optical Coherence Tomography Finding in Shaken-Baby Syndrome,” was co-authored by Rajeev H. Muni, MD, FRCSC; Radha P. Kohly, MD, PhD, FRCSC; Elliott H. Sohn, MD, and Thomas C. Lee, MD.

For more information, visit: www.thevisioncenteratchla.org