Utilising Digital Ocular Imaging for Paediatric Retinal Haemorrhages.

Aim: To evaluate the role of paediatric ocular imaging in paediatric ophthalmology through a case series, defining the retinal features observed in various paediatric pathological and trauma-related (abusive or non-abusive) conditions in patients aged four weeks to 16 years in a tertiary paediatric hospital in Dublin, Ireland.

Methods: A retrospective record-based study was conducted at Children's Health Ireland (CHI) at Temple Street, analysing ocular images of patients aged four weeks to 16 years, spanning five years, from 2018 to 2022. Following pupillary dilation, retinal examinations were performed using the 'RetCam 3', a handheld device for supine examinations in younger children, or the 'Topcon KR 800' for older patients. Images were reviewed with haemorrhages categorised by number, size, and location. Demographic and clinical details were tabulated, with counts and percentages calculated for categorical variables. Odds ratios and 95% confidence intervals (CI) were derived using the Mantel-Haenszel method, with statistical significance set at p-value <0.05.

Results: Of the 25 cases that met the age category of four weeks to 16 years, RHs were most common in infants (16 cases). Retinopathy of prematurity (ROP) was identified in nine cases (age range: 2 mo - 19 mo, mean age 7 mo), presumed trauma in five cases (age range: 2 mo - 10 mo, mean age 6 mo), metabolic/genetic conditions in four cases (age range: 8 mo - 8 years), infections in two cases, tumours in two cases, and three cases with no confirmed diagnosis. Most RHs were few, intraretinal, located in the posterior pole and periphery of the eye. RH incidence was significantly higher in ROP and trauma cases (p = 0.027), with an odds ratio of 1.4 (95% CI: 0.08 - 25.14). ROP cases showed small, localised haemorrhages, while cases of presumed trauma had multilayer and large (> 5 disc diameter (DD)) haemorrhages (p = 0.058) that extend to the ora serrata (p = 0.018).

Discussion: The study highlights paediatric ocular imaging's role in documenting RH patterns, aiding differential diagnosis across paediatric conditions. Paediatric ocular imaging's detailed capabilities provide clinical insights, reducing the need for multiple exams while promoting standardised documentation. Integrating ocular imaging technology supports establishing national guidelines and training programs that improve accessibility across diverse healthcare settings. Future research should validate these findings through multi-modal approaches and standardised practices, exploring paediatric ocular imaging utility in routine paediatric care. Additionally, advancements in artificial intelligence (AI) can further improve retinal examination efficiency, ultimately enhancing paediatric ophthalmology and child welfare in Ireland.