Chapter 9

■Photographic imaging of the pediatric fundus can be performed with one of several cameras, including noncontact imaging devices such as standard 30, 45, 50, and 60 cameras or Optos™, or they can be imaged with contact systems using RetCam™ or Panoret™.

■RetCam™ imaging depends on a light source that emanates from the lens handpiece.

■RetCam™ can provide a 30˚, 80˚, 120˚, or 130˚ image of the retina or even a full face portrait depending on the lens employed.

■RetCam™ can provide high-resolution wide-angle fluorescein angiography images using an appropriate filter.

■RetCam™ can provide gonioscopic images using the standard lens, contact gel, and defocusing to the front of the eye.

■RetCam™ can provide anterior segment images of the conjunctiva, cornea, or iris with removal of the lens.

■RetCam™ is usually performed with the child under anesthesia, but can be performed in the office with secure child restraint, topical anesthesia, and eyelid speculum.

■Ideal fundus images with RetCam™ are obtained in young children with wide dilation and without crystalline lens or media opacity.

■Poor fundus images with RetCam™ are the result of inadequate dilation leading to poor transmission of light and a central dark spot on imaging. Media opacity in the cornea, lens, or vitreous precludes sufficient light transmission for fundus illumination and results in poor image. Reflections off intraocular lens cause substantial glare and poor image.

9.1  Fundus Cameras

Imaging of the ocular fundus is important for documentation of numerous retinal and choroidal conditions. Fundus photography is especially important for documentation of intraocular tumors in children and adults. Photograph can be used to judge tumor size and extent, related features, and quantify response following therapy. However, fundus photography can be especially challenging in children because of the lack of cooperation for a

1Support provided by the Retina Research Foundation of the Retina Society in Cape Town, South Africa, a donation from Michael, Bruce, and Ellen Ratner, New York, NY, Mellon Charitable Giving from the Martha W. Rogers Charitable Trust, Philadelphia, PA, the LuEsther Mertz Retina Research Foundation, New York, NY, and the Eye Tumor Research Foundation, Philadelphia, PA.

still photograph of the interior of the eye. Most fundus photography on young children, under the age of 5 years, is performed in the operating suite with the child under general anesthesia.

One important limiting factor of fundus imaging is adequate fundus illumination. The small pupillary aperture, even when fully dilated, can inhibit adequate illumination of the interior of the eye for image capture. In most photographic systems, transpupillary light transmission is employed, where the light is aimed through the pupil, whereas in other systems, transcleral light transmission is used, where a brilliant light source is directed through the sclera. There are currently several fundus imaging systems available for children, most of which use transpupillary illumination techniques, and include standard fundus photography, RetCam™, and Optos™ imaging. Those that use the transcleral technique include Pomerantzeff and Panoret™ systems. Other considerations for fundus imaging