Imaging the pediatric retina

Abstract

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases

“…Hsu et al also found using OCTA that age, race and axial length are factors that influence quantitative parameters when imaging the pediatric perifoveal vasculature [ 15 ]. Image optimization is needed in pediatric eyes due to increasing axial length with age, evolving refractive status, steeper cornea and greater astigmatism in the first 6 months of life [ 9 ]. Moving forward, more work is needed to validate different portable OCT and OCTA over populations of various ethnicities.…”

“…B scan ultrasonography is a non-invasive imaging modality that detects large retinal or choroidal lesions [ 9 ]. Compared with OCT, B scan ultrasonography has a much lower resolution and OCT is much more precise in detecting pre-retinal, intra-retinal and subretinal lesions.…”

The Development and Clinical Application of Innovative Optical Ophthalmic Imaging Techniques

“…Some measurements obtained, mostly from the fovea, could potentially be used to screen for conditions like ROP (132). HH-OCT-A in specific is extremely useful in cases of CNV in children, such as ROP, retinal dystrophies, inflammatory disorders, trauma or cases of unexplained visual loss (134)(135)(136). Ocular measurements, specifically RNFL thickness, have been shown to be associated with systemic health conditions in infants (low birth weight, sepsis, and necrotizing enterocolitis) (137).…”

Paediatric orbital ultrasound: Tips and tricks

“…The added advantages of its use in children include lack of ionising radiation, reduced requirement of sedation or general anaesthesia and a quick comprehensive evaluation in an often apprehensive child. 1 Detailed crosssectional anatomy of the entire globe and surrounding orbital structures can be visualised using conventional ultrasound transducers. The cornea and anterior chamber structures of the eye rarely require ultrasound as they are amenable to clinical inspection, slit lamp and ophthalmoscopic examination.…”

“…Ultrasound examination is rapid, cost‐effective, easily available and enables dynamic study of the orbital structures. The added advantages of its use in children include lack of ionising radiation, reduced requirement of sedation or general anaesthesia and a quick comprehensive evaluation in an often apprehensive child 1 . Detailed cross‐sectional anatomy of the entire globe and surrounding orbital structures can be visualised using conventional ultrasound transducers.…”