Simplifying the Diagnosis of Pediatric Nystagmus with Fundus Photography

To simplify diagnosing congenital and acquired nystagmus using fundus photographs.

A retrospective study included patients with congenital or childhood-acquired nystagmus examined at a hospital-based ophthalmology clinic (September 2020-September 2023) with fundus photos taken. Exclusions were for incomplete data or low-quality images. Demographics, aetiology, orthoptic measurements, and ophthalmologic and neurological exams were reviewed. Two independent physicians graded fundus photos based on amplitude (distance between "ghost" images), the number of images visible, and the direction of nystagmus. Severity was rated on a 0-3 scale using qualitative and quantitative methods. Photographic findings were compared to clinical data, and statistical analysis used Mann-Whitney tests.

A total of 53 eyes from 29 patients (16 females, 13 males; mean age 12.5 years, range 3-65) were studied: 25 with binocular nystagmus and 3 with monocular nystagmus. Diagnoses included congenital (n = 15), latent-manifest (n = 3), neurologically associated (n = 2), and idiopathic (n = 9). Types observed were vertical (n = 5), horizontal (n = 23), rotatory (n = 10), and multidirectional (n = 15). Visual acuity ranged from 20/20 to no light perception. Fundus photos correlated with clinical diagnoses, aiding qualitative assessment of direction and amplitude and mitigating eye movement effects for clearer retinal detail visualization.

Fundus photography effectively captures nystagmus characteristics and retinal details, even in young children, despite continuous eye movements. Integrating fundus cameras into routine practice may enhance nystagmus diagnosis and management, improving patient outcomes.