Retina Specialists of Michigan, Grand Rapids, Michigan, USA
Purpose: To describe UWFP for assessment and monitoring of posterior pediatric pathology. UWFP can improve clinical assessment and potentially decrease the burden of examinations under anesthesia for pediatric patients with conditions such as retinopathy of prematurity, retinoblastoma, traumatic injury, hereditary disease, retinal detachment, among others.
Methods: The smaller and variable body habitus of pediatric patients results in a need for variations to standard positioning for image acquisition, such closer eye position to the scanning laser for proper image focus compared to an adult. Ergonomic changes to acquire images that help with this include removing chin and forehead rests, as well as the face guard. Nystagmus, bodily movements, blinking, crying, poor cooperation, and parental anxiety can limit quality imaging capturing. Using additional aids and measures to prevent artifacts and enhance attentive gaze includes swaddles, speculums, pacifiers, allowing the patient to be imaged with minimal persons in the room, among others.
Results: UWFP allows for improved clinical assessment, often above what can be acquired through a provider’s examination in an otherwise challenging pediatric population. UWFP is able to capture a wider field of view, in which allows for more of an understanding of the disease burden compared to conventional contact-based imaging. The images produced can be used as an educational tool for understanding clinical explanations of diseases and treatments to family members. This may potentially decrease the need for scheduling examinations under anesthesia for diagnostic purposes and may reduce theoretical anesthesia-associated risks.
Conclusion: UWFP offers diagnostic utility and objective comparative analysis through time when monitoring posterior pathology and enhancing treatment decisions. Understanding ways to refine image acquisition in a challenging pediatric population can improve image quality, decrease image acquisition time, and prevent artifacts.