It can be difficult to examine small children for any problems in the eye. So pediatric ophthalmology is a challenging field. Recently, new methods of imaging in pediatric ophthalmology have led to change in the treatment making it easy and effective. Anterior-segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), and corneal topography help to identify the type or extent of anatomical anomalies and root causes, promote the follow-up of a diagnosis over time that helps in the decision-making process and formulates an appropriate management strategy, and focus attention on the neurologic effects.
Optical coherence tomography is the most common and popular technique used for imaging in pediatric ophthalmology. It is quick, non-invasive technology and makes use of optical waves and interferometry, generates high-resolution tomograms in vivo, and displays malignancies that could otherwise go undetected. OCT is most widely used in the pediatric population to obtain retinal nerve fiber layer (RNFL) measurement.
Two new imaging technologies The RetCam (Clarity Medical Systems) and the Optos (Optos Inc.) have revolutionized the care of pediatric ophthalmology patients.
The RetCam (Clarity Medical Systems) is a contact lens-based system and provides 120 to 130 degrees of view which need pupil dilatation and clear cameras, and while the imaging can be conducted in awake premature infants or neonates older children need to be sedated. The RetCam device is useful for recording fundus images under anesthesia at the inspection in the operating room. The RetCam images are immediately accessible in real-time but the resolution is poor, the device also has video capabilities and is particularly useful in the operating room for FA. The RetCam program changed the paradigm of premature retinopathy (ROP) and retinoblastoma patients. This is also useful for children with possible non-accidental damage in hospital visits and in other cases, such as viral retinitis, where retinal results need to be closely recorded.
The Optos is a confocal dual-laser system and can be used in awake patients of any age. This system is ideal for clinic use. In a pediatric ophthalmology clinic, it can be used with or without a speculum in young infants using a ‘flying boy’ technique. Yet a downside is the absence of real-time imagery. It has a useful fundus autofluorescence mode and features FA and indocyanine green angiography.