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Nonmydriatic Fundoscopic Imaging Using the Pan Optic iExaminer System in the Pediatric Emergency Department
Lindsay M Day1, Serena X Wang2, Craig J Huang1
1Department of Pediatrics, Division of Pediatric Emergency Medicine, Dallas, TX.
Insights
The Pan Optic iExaminer effectively captures clinically adequate fundoscopic images in children aged 2-18 years in pediatric emergency departments. While useful for younger children, image acquisition is less consistent in those under two years old.
Area of Science:
- Ophthalmology
- Pediatric Emergency Medicine
- Medical Imaging Technology
Background:
- Nonmydriatic fundoscopic imaging is crucial for diagnosing various pediatric eye conditions.
- The Pan Optic iExaminer system offers a portable solution for fundus imaging.
- Evaluating the efficacy of new imaging technologies in the pediatric emergency department (ED) setting is essential.
Purpose of the Study:
- To determine the percentage of clinically adequate (CA) fundoscopic images obtained with the Pan Optic iExaminer in a pediatric ED.
- To identify optimal age groups for utilizing this nonmydriatic fundus imaging technology.
- To assess the overall ease of use of the iExaminer system in a pediatric ED.
Main Methods:
- Children aged 18 or younger presenting to a pediatric ED were enrolled and categorized into age groups (0-2, 2-6, 6-18 years).
- Bilateral eye examinations were performed using the Pan Optic iExaminer, with images graded for clarity and field of view by a pediatric ophthalmologist.
- Clinically adequate images, examination time, and attempt numbers defined the ease of use criteria.
Main Results:
- Over 91% of children aged 2-18 years had at least one clinically adequate fundoscopic image obtained.
- Success rates for CA images varied by age: 16% for 0-2 years, 85% for 2-6 years, and 97% for 6-18 years.
- The median examination time was approximately 3.5 minutes, well within the defined ease-of-use parameters.
Conclusions:
- The Pan Optic iExaminer system consistently yields clinically adequate fundoscopic images in pediatric patients aged 2-18 years within the ED setting.
- While the technology shows promise for younger children (<2 years), image acquisition is less reliable in this age group.
- The system demonstrates good ease of use and efficiency for nonmydriatic fundus imaging in pediatric emergency care.
Objectives:
The primary objective of this study was to determine the percentage of clinically adequate (CA) fundoscopic images that could be obtained using the Pan Optic iExaminer system to perform nonmydriatic fundoscopic imaging in the pediatric emergency department (ED). Secondary objectives were to identify target age groups in which this technology is best utilized and evaluate the overall ease of use in this setting.
Methods:
Children 18 years of age or less who presented to the pediatric ED with a non-eye-related chief complaint were enrolled and stratified by age group (0-2, 2-6, and 6-18 years). Each enrolled patient underwent a bilateral eye examination using the Pan Optic iExaminer system. Images were submitted for review to a pediatric ophthalmologist and were graded based on clarity and field of view. Ease of use was defined as 80% of patients having at least one image of quality to be considered "clinically adequate" for obtaining a full view of the optic nerve, examination time for both eyes 15 minutes or less, and three attempts or less for each eye.
Results:
Overall, 91.06% (95% confidence interval [CI] = 86.01% to 96.1%) of children ages 2-18 years had at least one CA image obtained. A total of 16% (95% CI = 7% to 26%) of children 0-2 years, 85% (95% CI = 76% to 94.15%) of children 2-6 years, and 9% (95% CI = 92% to 100%) of 6-18 years had at least one CA image. The median total examination time was 3 minutes 24 seconds (interquartile range = 2 minutes 27 seconds to 4 minutes 49 seconds).
Conclusion:
Fundoscopic images were consistently obtained using the Pan Optic iExaminer system in the pediatric ED particularly in children 2-18 years of age. CA images were obtained in children less than 2 years old, but less consistently.
