Imaging Device May Help Diagnose Shaken Baby Syndrome

A hand-held spectral domain optical coherence tomography (SD-OCT) device could provide high-resolution images of the retina and the vitreoretinal interface in infants with shaken baby syndrome (SBS).

Researchers at Children's Hospital Los Angeles (CHLA; CA, USA) examined 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 a retinal camera, and imaging with the handheld SD-OCT device. The SD-OCT documented focal posterior vitreous separation in four of the five eyes with multilayered retinoschisis in one eye, disruption of the foveal architecture and foveolar detachment in one eye, and disinsertion of the internal limiting membrane or inner retinoschisis in one eye. In addition, preretinal hemorrhages were documented in all five eyes, and all patients had vitreoretinal abnormalities not detected on clinical examination. The study was published in the April 2010 issue of Retina, the journal of retinal and vitreous diseases.

"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,” said study coauthor Thomas Lee, M.D., director of the retina institute in The Vision Center at CHLA. "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.”

SBS is a form of child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries. The injury is estimated to affect between 1,200 and 1,600 children every year in the United States alone. SBS is often fatal and can cause severe brain damage, resulting in lifelong disability. Estimated death rates among infants with SBS range from 15-38%, with a median of 20–25%. The nonaccidental trauma in SBS has been associated with retinal findings, including hemorrhages in all layers of the retina and retinoschisis. Optical coherence tomography uses near-infrared and other long wavelength light to penetrate deep inside the eye, enabling a close-up look at tissues not visible with traditional camera technology.

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