OSLI Retina

September 2019

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580 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Comparison of Digital Widefield Retinal Imaging With Indirect Ophthalmoscopy in Pediatric Patients Hema L. Ramkumar, MD; Megha Koduri, BS; Jordan Conger, MD; Shira L. Robbins, MD; David Granet, MD; William R. Freeman, MD; Luke Saunders, PhD; Henry Ferreyra, MD; Robert N. Weinreb, MD; Eric Nudleman, MD, PhD BACKGROUND AND OBJECTIVE: Approximately 16,000 children in the United States lose vision each year because of retinal disease. The authors compare digital ultra-widefield (UWF) photogra- phy to indirect ophthalmoscopy in children. PATIENTS AND METHODS: Prospective, single-center study of patients ages 3 to 17 years. Retinal area dur- ing indirect ophthalmoscopy was compared with retinal area in digital UWF fundus photographs. Image quality was graded. A survey to assess the usefulness of the retinal image was obtained. RESULTS: The retinal area (mean ± standard devia- tion, mm 2 ) evaluated with indirect ophthalmosco- py was 413 ± 194 mm 2 , compared with 652 ± 117 mm 2 with widefield photography (P < .001). The difference was largest in children younger than 14. Image quality was significantly associated with pa- tient cooperation. CONCLUSIONS: High-quality UWF photographs evaluate more peripheral retina than the in-office dilated funduscopic exam in children under 14. Photography assisted with family counseling in 17% of patients and the avoidance of examination under anesthesia in 2% of patients. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:580-585.] INTRODUCTION Pediatric fundus exam can be limited due to lack of cooperation. Widefield digital imaging is capable of capturing images in less than 1 minute using a non- contact system. 1 Previous studies have demonstrated comparable ability of widefield imaging to detect pathology compared with indirect ophthalmoscopy in adults. 2 Here, we aimed to determine if high qual- ity ultra-widefield (UWF) images can be reliably ob- tained from dilated pediatric patients, and compared them to indirect ophthalmoscopy. PATIENTS AND METHODS Data Collection This study was approved by the Institutional Re- view Board of the University of California San Di- ego and followed the Declaration of Helsinki. In this study, 173 patients between the ages of 3 years and 17 years were enrolled for retinal evaluation and UWF retina photography at the University of California, San Diego from January to December 2016. Each physician in the study completed survey questions before photography, after the dilated ex- amination, and after viewing the UWF photo. Prior to photography, the patient's ethnicity, pre-exiting retinal diagnosis, and cooperativity (low, medium, or high) were measured. The patient received dilation with a combination drop comprised of cyclopento- late 2%, tropicamide 1%, and phenylephrine 10% in a 6:3:2 ratio. From the Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California (HLR, MK, JC, SLR, DG, WRF, LS, HF, RNW, EN); Retina Consultants of Orange County, Fullerton, California (HLR); and the Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, California (JC). Originally submitted July 28, 2018. Revision received January 28, 2019. Accepted for publication March 11, 2019. Supported by the Thrasher Foundation. Presented as an e-poster at the American Society of Retina Specialists meeting in 2017. Dr. Weinreb received the Optos machine used in this study as a gift from the company. Dr. Nudleman is a consultant for Allergan, Alcon, and Visunex Medical Systems outside the submitted work. The remaining authors report no relevant financial disclosures. Address correspondence to Hema L. Ramkumar, MD, 301 W Bastanchury Rd. Suite 285, Fullerton, CA 92835; email: hemaLramkumar@gmail.com. doi: 10.3928/23258160-20190905-07 ■ I M A G I N G R E V I E W ■

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