Abstract
Aims:Dilated fundus examinations are a vital, yet time-consuming and sometimes distressing part of paediatric ophthalmology examinations. Limited resources, personnel and time can result in prolonged waiting time and increase risk from delayed diagnosis and treatment. Using a Nikon D80 TopCon TRC-NW6S non-mydriatic fundus camera (TopCon (GB) Ltd, Newbury), we aimed to demonstrate the safety and efficacy of orthoptic-led fundus digital imaging and the potential time and cost benefits to the healthcare system.Methods:We conducted a retrospective review of all digital fundus images taken over a six month period in 2012 (n = 616, age range 2.1–16.5 years, mean age 8.7 years).Results:Overall success rate for paediatric fundus digital imaging was 97%. Successful images were achieved in 87% of patients without the need for pupil dilation. Images were taken for a variety of clinical reasons. 45% of patients were discharged immediately, many with copies of photographs to facilitate follow-up with community optometrists.Conclusions:Orthoptic-led fundus digital imaging is an innovative, speedy, safe and efficient method of documenting fundal appearance, enabling serial documentation of stability/progression of ocular disease. It allows adequate examination of routine patients, freeing up time within busy clinics. Paediatric fundus digital imaging brings a potential positive cost benefit to healthcare systems under pressure, and facilitates skill development for allied health professionals.
Highlights
Ocular fundus digital imaging is a well-established digital imaging method for documenting the retinal and optic nerves appearance. It is widely recognised as standard practice throughout the UK in the retinopathy screening of type II diabetics (NHS 2011; Sharp et al 2003) and routinely used in conjunction with fluorescein angiographies in the diagnosis and management of adults with diabetic and ischaemic eye disease, choroidal neovascularisation, and papilloedema
In young babies and infants with retinopathy of prematurity (ROP), retinoblastoma and suspected abusive head trauma, fundal appearance is documented with contact retinal imaging (e.g. Retcam, Clarity Medical Systems, CA, USA) and emerging ultrawidefield imaging technologies (e.g. Optos camera, Optos PLC, Dunfermline, UK)
We aim to present the many advantages of fundus digital imaging becoming a routine part of multi-disciplinary paediatric ophthalmology assessment and the potential positive impact on healthcare systems
Summary
Ocular fundus digital imaging is a well-established digital imaging method for documenting the retinal and optic nerves appearance. It is widely recognised as standard practice throughout the UK in the retinopathy screening of type II diabetics (NHS 2011; Sharp et al 2003) and routinely used in conjunction with fluorescein angiographies in the diagnosis and management of adults with diabetic and ischaemic eye disease, choroidal neovascularisation, and papilloedema. In young babies and infants with retinopathy of prematurity (ROP), retinoblastoma and suspected abusive head trauma (non-accidental injury), fundal appearance is documented with contact retinal imaging (e.g. Retcam, Clarity Medical Systems, CA, USA) and emerging ultrawidefield imaging technologies (e.g. Optos camera, Optos PLC, Dunfermline, UK).
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