Hand Held Imaging Device Provides Important Evidence in Diagnosis of Shaken Baby Syndrome

Newswise — 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 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 with 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 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 treat 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 Childrens Hospital Los Angeles 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.

About The Vision Center – “Where all eye conditions receive extraordinary care.” The Vision Center at Childrens Hospital Los Angeles is an international referral center known for its family friendly environment of children afflicted with all forms of eye disease and provides a full range of inpatient and outpatient services. It is the largest pediatric ophthalmology program in the nation with multiple subspecialty programs that are considered to be among today’s finest resources for diagnosis, treatment and research.

Founded in 1901, Childrens Hospital Los Angeles has been treating the most seriously ill and injured children in Los Angeles for more than a century, and it is acknowledged throughout the United States and around the world for its leadership in pediatric and adolescent health. Childrens Hospital is one of America’s premier teaching hospitals, affiliated with the Keck School of Medicine of the University of Southern California since 1932. The Saban Research Institute of Childrens Hospital Los Angeles is among the largest and most productive pediatric research facilities in the United States.