Pediatric Retinal Conditions

How do you know if your child has retina problems?

Some symptoms of pediatric retinal conditions, such as poor night vision or sudden vision loss, very obviously indicate that there’s a problem. Other symptoms to keep an eye out for include:

• Chronic eye discomfort
• Alignment issues (ex. crossed eyes)
• Discolored pupils
• Lack of eye contact
• The inability to follow an object with their eyes
• Chronic eye redness
• Drooping eyelids

Diagnostic Methods for Pediatric Retinal Diseases

There are several diagnostic tests that can be utilized when diagnosing pediatric retinal diseases. Some of these include:

• Extensive eye exam: An extensive eye exam will typically include eye dilation, which is when special eye drops are used to keep the pupil open and allow the physician to take a better look at the retinal area. The exam may also include a scleral depressor, which is a special instrument that is used to stabilize the eye’s position. Eye doctors also use ophthalmoscopes, which shine a light on the retinal area.
• Visual field testing: Visual field testing helps doctors measure a patient’s central and peripheral vision. Each eye is tested individually. This test can help reveal blind spots in your vision as well as any irregularities.
• Fluorescein angiography: In this test, a colored dye is injected into the arm so that it can travel to the ocular blood vessels. Once it has reached the retinal vasculature, a specialized camera is used to capture images of abnormalities in the macula or retinal blood vessels.
• Optical coherence tomography (OCT): OCT utilizes infrared light to take cross-sectional images of the retina and macula. This test is useful in determining whether or not any fluid has leaked into the retinal region or if there is any damage in the area.
• Ultrasound: In this non-invasive diagnostic technique, high-frequency sound waves are used to produce an image of the retina and macula. It is useful for finding any structural issues or irregularities.
• Electroretinography: This test is used to determine the functionality of the retina by detecting electrical signals from the photoreceptor cells. Abnormal readings alert the physician that something is wrong in the retina.
• Fundus photography: Fundus photography involves the use of a precision microscope attached to a specialized flash camera to capture images of the back of the eye, also known as the fundus. The images help doctors make observations of abnormalities in the optic nerve, retinal blood vessels, scar tissue, atrophy, and more.

Treatments for Pediatric Retinal Diseases

Treatment for pediatric retinal conditions varies and is highly dependent on the disease in question as well as how far the disease has progressed. In most cases, there is no formal treatment available. That being said, there are some treatment options that can help stave off vision loss.

• Focal laser therapy or surgery, also known as photocoagulation: Photocoagulation uses a high-energy laser beam to break down damage in the blood vessels or to seal leaking blood vessels. It can be used for conditions that affect the retinal blood vessels, such as retinopathy of prematurity, Coats disease, and FEVR.
• Cryopexy (freezing): Cryopexy is sometimes used to treat retinal tears to prevent them from developing into a full retinal detachment. The procedure works by applying a freezing probe to the surface area above where the tear has occurred, causing scar tissue to form around the tear, which stabilizes the retina and keeps it secured to the wall of the eye. This procedure may be used in conditions where the risk of retinal detachment is imminent, such as retinopathy of prematurity, Coats disease, or FEVR.
• Vitrectomy: In a vitrectomy, the vitreous humor fluid is surgically removed from the inside eye so that the retina and macula can be repaired. The fluid is then replaced with a similar substance, such as saline, silicone, or a gas bubble. This procedure is commonly used to manage a wide variety of retinal and macular issues.
• Scleral buckle: A scleral buckle is a procedure in which a piece of sponge or silicone is secured to the sclera, which is the white part of the eye. This procedure is typically used to treat retinal detachment. The sponge or silicone piece is secured close to where the tear has formed so that it can push the retina back into position.
• Anti-vascular endothelial growth factor (anti-VEGF) medications: This group of medications, which includes Avastin, Lucentis, and Eylea, are injected directly into the eye to inhibit the growth of abnormal blood vessels.

While these treatment options can help fend off the worst effects of pediatric retinal conditions, they are not true cures for many of these diseases. Currently, there are several research initiatives that are dedicated to finding cures or improved treatment options for these conditions.