title: Feasibility and quality of nonmydriatic fundus photography in children.
abstract: OBJECTIVE
  Ocular funduscopic examination is difficult in young children and is rarely attempted by nonophthalmologists. Our objective was to determine the feasibility of reliably obtaining high-quality nonmydriatic fundus photographs in children.
  
  
  METHODS
  Nonmydriatic fundus photographs were obtained in both eyes of children seen in a pediatric ophthalmology clinic. Ease of fundus photography was recorded on a 10-point Likert scale (10 = very easy). Quality was graded from 1 to 5 (1, inadequate for any diagnostic purpose; 2, unable to exclude all emergent findings; 3, only able to exclude emergent findings; 4, not ideal, but still able to exclude subtle findings; and 5, ideal quality). The primary outcome measure was image quality by age.
  
  
  RESULTS
  A total of 878 photographs of 212 children (median age, 6 years; range, 1-18 years) were included. Photographs of at least one eye were obtained in 190 children (89.6%) and in both eyes in 181 (85.3%). Median rating for ease of photography was 7. Photographs of some clinical value (grade ≥2) were obtained in 33% of children <3 years and 95% ≥3 years. High-quality photographs (grade 4 or 5) were obtained in both eyes in 7% of children <3 years, 57% of children ≥3 to <7 years, 85% of children ≥7 to <9 years, and 65% of children ≥9 years. The youngest patient with high-quality photographs in both eyes was 22 months.
  
  
  CONCLUSIONS
  Nonmydriatic fundus photographs of adequate quality can be obtained in children over age 3 and in some children as young as 22 months.
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia 30822, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Toffoli
authors.forename: Beau B
authors.initials: BB
authors.lastname: Bruce
authors.forename: Cédric
authors.initials: C
authors.lastname: Lamirel
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Henderson
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Newman
authors.forename: Valérie
authors.initials: V
authors.lastname: Biousse
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005128:Eye Diseases / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D007223:Infant; D008297:Male; D009184:Mydriatics; D009887:Ophthalmoscopy / Q000379:methods* / Q000592:standards; D010781:Photography / Q000592:standards*
chemical_list: D009184:Mydriatics