Clinic-based ultra-wide field retinal imaging in a pediatric population

Abstract

Background: Pediatric retinal disorders, although uncommon, can be challenging to assess in the clinic setting and often requires an exam under anesthesia. The purpose of our study was to evaluate the use of ultra-wide field retinal imaging in children without sedation in an outpatient clinic.

Methods: We performed a retrospective case series of patients 18 years or younger who received ultra-wide field imaging over a one year period. The age, gender, and clinical course were documented. Color fundus and red-free images were reviewed to assess field of view. Ultra-wide field autofluorescence (UWF-FAF) was evaluated for abnormal autofluorescence patterns and ultra-wide field fluorescein angiography (UWF-FA) was assessed for angiographic phase and field of view.

Results: A total of 107 eyes of 55 patients with a mean age of 11.1 years (SD 3.7 years, range 3-18 years) were evaluated. Twenty-seven (49%) patients were male. The most common diagnosis was retinopathy of prematurity (7 of 55 patients, 12.7%) followed by trauma (7.4%), Coats disease (7.4%), and rhegmatogenous retinal detachment (7.4%). The number of quadrants visualized anterior to the equator correlated with patient age (r = 0.4, p < 0.01). On UWF-FA, 6 of 14 patients (43%) had images of the arterial phase captured and 14 of 14 patients (100%) had images of the venous phase or later captured.

Conclusions: We demonstrated that UWF imaging is obtainable in children as young as 3 years old without sedation. UWF fundus photography, UWF-FAF and UWF-FA were useful clinical adjuvants to examination and provide additional information for documenting and monitoring pediatric retinal diseases.

Keywords: Fluorescein angiography; Pediatric imaging; Wide-field imaging.

Fig. 1

Color and red free fundus photography in pigmented paravenous chorioretinal atrophy. a The color photograph demonstrates visualization of most quadrants with lash artifacts inferiorly and nose artifacts temporally in a patient. b The red free photographs help illustrate the vortex veins (white arrows) to define the equator. Quadrants visualized were defined based on visualization posterior to the equator

Fig. 2

Color and autofluorescence fundus photography in a cone-rod dystrophy. a The color photograph demonstrates hypopigmentary specks in the mid-peripheral retina. b The fundus autofluorescence demonstrates a ring of hypo and hyperautofluorescence (Robson–Holder ring) and hypoautofluoresent flecks in the mid-periphery

Fig. 3

Color fundus photography demonstrating multiple retinal astrocytomas (white arrows) in both eyes of a patient with tuberous sclerosis. a Right eye, b left eye

Fig. 4

Ultra-wide field fluorescein angiography demonstrates peripheral telengectatic vessels, nonperfusion, and leakage in Coats disease. The patient subsequently underwent an EUA with targeted panretinal photocoagulation

Fig. 5

In a patient with retinopathy of prematurity previously treated with laser ablation, ultra-wide field fluorescein angiography demonstrates no leakage. Notably there is temporal dragging

Fig. 6

Ultra-wide field color fundus photography (a) and fluorescein angiography (b) demonstrates chorioretinal scars from previous laser treatment and an area of neovascularization nasally in patient treated for Coats disease