Close Up & Personal
As an ophthalmic surgeon, Thomas C. Lee, MD, is accustomed to working in tight places. A newborn baby’s eye is smaller than a marble, making eye surgery like operating through a keyhole. To enter this miniscule territory and thwart a deadly disease that threatens a child with blindness, he relies on tools less than two millimeters in diameter.

Now, The Vision Center at Childrens Hospital Los Angeles has some amazing new imaging tools in its arsenal. They include spectral domain optical coherence tomography (OCT) and an endoscope (a long, slender medical instrument) with a special attachment: a camera.

One use for this new equipment is treating retinopathy of prematurity (ROP), a potentially blinding eye disorder that affects premature infants. The smaller a baby is at birth, the more likely he or she will develop ROP. Abnormal blood vessels grow and spread throughout the retina, the tissue lining the back of the eye. Most mild cases correct themselves. However, the vessels can leak, scarring the retina and pulling it out of position.

Being able to see what’s happening inside the eye in minute detail is critical. So is knowing exactly where the retina is detached. In the past, Dr. Lee, director of the Retina Institute in The Vision Center, has had to identify a detachment using a magnifying glass and a headset with a Halogen light. “It’s almost like you’re at the top of a building and you’re being asked to read the license plates on cars on the street below,” says Dr. Lee, associate professor of clinical ophthalmology at the Keck School of Medicine of the University of Southern California.

The answer is ultra-high resolution, three-dimensional (3D) optical imaging or spectral domain OCT. It has been used for about eight years in adults; however, adult-sized versions were too bulky to use for tiny newborns or at a child’s bedside.