Assessment of vision in paediatric primary care practice

Uvod: Procjena vidne funkcije često predstavlja izazov za pedijatra u primarnoj zdravstvenoj zaštiti. Međutim, zahvaljujući jednostavnosti osnovnih metoda procjene vida, pedijatar može adekvatno evaluirati vidne funkcije u djece. Test crvenog refleksa kao vitalni dio svakog preventivnog pregleda djeteta u pedijatrijskoj ordinaciji primarne zdravstvene zaštite je najvažniji alat za otkri- vanje opstrukcije vidne osi koja je uzrok nastanka deprivacijske slabovidnosti. Vidna os može biti opstruirana zbog različitih bolesti koje ugrožavaju vid ili život. Cilj: Predstaviti metode procjene vidne oštrine dostupne pedijatru u primarnoj zdravstvenoj zaštiti. Izvori podataka: PubMed, Google Scholar, Scopus, smjernice za preventivne preglede vida dostupne na internetu. Zaključak: U slučajevima sumnje na opstrukciju vidne osi, urgentno upućivanje na pregled dječjem oftalmologu je obavezno.Assessment of visual function often poses a challenge for a paediatrician in primary practice. However, due to the simplic- ity of basic visual assessment methods, paediatricians have the means to evaluate a child’s visual function. As a crucial part of every preventive physical examination of a child, the red reflex test is the most important tool for discovering obstruction of the visual axis as the cause of deprivational amblyopia. The visual axis can be obstructed due to various vision - or even life-threatening conditions. Aim: To present visual assessment methods available to the paediatrician in primary practice. Data source: PubMed, Google Scholar, Scopus, and available Internet screening guidelines. Conclusion: If obstruction of the visual axis is suspected, immediate referral to a paediatric ophthalmologist is mandatory

Optical Coherence Tomography Angiography – A New Insight Into Macular Vasculature

Optical coherence tomography angiography (OCT-A) is a new non-invasive technology for imaging of retinal and choroidal vasculature of the macular area with resolution comparable to histological sections. OCT-A does not require usage of intravenous dye, contrary to fluorescein angiography, the current gold standard for imaging of retinal vessels, and indocyanine-green angiography, which is important for imaging of choroidal vessels. With the advancements in optical coherence tomography (OCT) scanning speeds and creation of powerful algorithms for improvement of image quality in recent years, OCT-A imaging of macular vasculature, superficial, deep and avascular retinal complex, as well as choriocapillaris and deep choroid has become available in everyday clinical practice. This review covers aspects important for understanding choroidal and retinal blood supply, as well as the development, mechanisms and clinical application of OCT and OCT-A technology. (Bajtl D, Bjeloš M, Bušić M, Rak B, Križanović A, Kuzmanović Elabjer B. Optical Coherence Tomography Angiography – A New Insight Into Macular Vasculature. SEEMEDJ 2019; 3(2); 63-75

Biometric parameters of retinal perfusion and optical components of the eye in four-year-old children

Cilj istraživanja: Svrha ove studije koja je uključivala zdravu emetropnu četverogodišnju djecu bijele rase bila je osigurati normativnu bazu podataka o perfuziji makularne vaskularne mreže u 4-godišnje djece stečene optičkom koherentnom tomografskom angiografijom (OCTA) i optičkih parametara oka optičkom biometrijom (OB) i kornealnom tomografijom (KT). Nacrt studije: presječno istraživanje Bolesnici i metode: Jedno oko svakog ispitanika podvrgnuto je snimanju OCTA-om, OB-om i KT-om. Pomoću softvera AngioTool Image J analizirani su vaskularni parametri krvnih žila makule: područje krvnih žila (VA), područje krvnih žila unutar eksplantiranog područja (VD), ukupan broj grananja (TNJ), broj grananja koji je normaliziran prema jedinici površine (JD), ukupna dužina krvnih žila izražena u broju Euklideanskih udaljenosti unutar promatranog područja (TVL), srednja dužina svih krvnih žila unutar eksplantiranog područja (AVL), broj vaskularnih segmenata otvorenih krajeva (TNEP), lakunarnost (L) te površina fovealne avaskularne zone (FAZ), a ugrađenim softverom OCTA-uređaja generirane su prosječne vrijednosti debljine i volumena makule. OB-om su analizirani optički parametri. Pomoću KT-a dobiveni su parametri rožnice pomoću prikaza Belin-Ambrosio enhanced ectasia display (BAD) i Fourierove analize (FA). Rezultati: Istraživanjem je ispitano 180 očiju 180 djece prosječne starosti 48 (46 – 59) mjeseci. Krvne žile makule u četvrtoj godini života pokazuju visoku gustoću: najveći je prosječni VD u koriokapilarisu (cc) 79,26 %, dok u površinskom, srednjem i dubokom pleksusu pokazuje sličnu vrijednost: 65,16 %, 65,67 % i 67,05 %. VA i VD povećavaju se od unutarnjih prema vanjskim slojevima mrežnice. Prikazana su morfološka obilježja srednjeg kapilarnog pleksusa u ispitivanoj skupini. Podržana je spolna diferencijacija mrežnice s obzirom na spol, tj. dječaci bilježe značajno veće površine krvnih žila u odnosu na djevojčice u većini promatranih slojeva. U dobi od 4 godine oko ima značajke emetropnog oka: AX je 22,14 ± 0,59 mm, a oko ima jakost od 25,96 ± 1,38 D. Rožnica u ispitivanoj skupini pokazuje tomografska obilježja odrasle rožnice: oblik rožnice je prolatni, a zakrivljenost prednje površine rožnice K1 i K2 iznosi: 42,92 ± 1,29 D i 43,75 ± 1,41 D. Parametri BAD i FA prosječnih su vrijednosti sličnih onima odraslih ispitanika. Zaključak: Studija daje prvu detaljnu normativnu bazu podataka o makularnoj vaskularnoj mreži i optičkim obilježjima oka u najmlađoj uniformnoj kohorti emetropne četverogodišnje djece.Objective: The purpose of this study, which included healthy emetropic four-year-old Caucasian children, was to provide a normative database on perfusion of macular vascular network in 4-year-old children acquired by optical coherence tomography (OCTA) and optical eye parameters by optical biometrics and corneal tomography (KT). Study design: cross-sectional research Patients and Methods: One eye of each subject underwent OCTA, OB, and KT imaging. The following parameters were analyzed using AngioTool Image J software: vessels area (VA), vessels density (VD), the total number of junctions (TNJ), junctions density (JD), total vessel length (TVL), average vessel length (AVL), the total number of endpoints (TNEP), lacunarity (L), vessel diameter index (VDI) and foveal avascular zone (FAZ) area. Built-in OCTA device software generated average macular thickness and volume values. Optical parameters were analyzed by OB. Corneal parameters were obtained by KT using the Belin-Ambrosio Enhanced Ectasia Display (BAD) and Fourier analysis (FA). Results: The study examined 180 eyes of 180 children with an average age of 48 (46–59) months. Macular blood vessels in the fourth year of life demonstrate high density: the highest average VD is in the choriocapillaris (cc) 79.26%, while in the superficial, middle, and deep plexus it measures similar values: 65.16%, 65.67%, and 67.05 %. VA and VD increase from the inner to the outer layers of the retina. Morphological features of the middle capillary plexus in the examined group are presented. Gender differentiation of the retina with respect to sex was supported, i.e., boys recorded significantly larger blood vessel areas compared to girls in most of the observed layers. At the age of 4, the eye has the characteristics of an emetropic eye: AX is 22.14±0.59 mm, and the eye has a strength of 25.96±1.38 D. The cornea in the study group indicates tomographic features of the adult cornea: the shape of the cornea is prolate, and the curvature of the anterior surface of the cornea K1 and K2 are: 42.92±1.29 D and 43.75±1.41 D. The parameters of BAD and FA are average values, similar to those of adult subjects. Conclusion: The study provides the first detailed normative database on macular vascular network and optical features of the eye in the youngest uniform cohort of emmetropic four-year-old children

Biometric parameters of retinal perfusion and optical components of the eye in four-year-old children

Cilj istraživanja: Svrha ove studije koja je uključivala zdravu emetropnu četverogodišnju djecu bijele rase bila je osigurati normativnu bazu podataka o perfuziji makularne vaskularne mreže u 4-godišnje djece stečene optičkom koherentnom tomografskom angiografijom (OCTA) i optičkih parametara oka optičkom biometrijom (OB) i kornealnom tomografijom (KT). Nacrt studije: presječno istraživanje Bolesnici i metode: Jedno oko svakog ispitanika podvrgnuto je snimanju OCTA-om, OB-om i KT-om. Pomoću softvera AngioTool Image J analizirani su vaskularni parametri krvnih žila makule: područje krvnih žila (VA), područje krvnih žila unutar eksplantiranog područja (VD), ukupan broj grananja (TNJ), broj grananja koji je normaliziran prema jedinici površine (JD), ukupna dužina krvnih žila izražena u broju Euklideanskih udaljenosti unutar promatranog područja (TVL), srednja dužina svih krvnih žila unutar eksplantiranog područja (AVL), broj vaskularnih segmenata otvorenih krajeva (TNEP), lakunarnost (L) te površina fovealne avaskularne zone (FAZ), a ugrađenim softverom OCTA-uređaja generirane su prosječne vrijednosti debljine i volumena makule. OB-om su analizirani optički parametri. Pomoću KT-a dobiveni su parametri rožnice pomoću prikaza Belin-Ambrosio enhanced ectasia display (BAD) i Fourierove analize (FA). Rezultati: Istraživanjem je ispitano 180 očiju 180 djece prosječne starosti 48 (46 – 59) mjeseci. Krvne žile makule u četvrtoj godini života pokazuju visoku gustoću: najveći je prosječni VD u koriokapilarisu (cc) 79,26 %, dok u površinskom, srednjem i dubokom pleksusu pokazuje sličnu vrijednost: 65,16 %, 65,67 % i 67,05 %. VA i VD povećavaju se od unutarnjih prema vanjskim slojevima mrežnice. Prikazana su morfološka obilježja srednjeg kapilarnog pleksusa u ispitivanoj skupini. Podržana je spolna diferencijacija mrežnice s obzirom na spol, tj. dječaci bilježe značajno veće površine krvnih žila u odnosu na djevojčice u većini promatranih slojeva. U dobi od 4 godine oko ima značajke emetropnog oka: AX je 22,14 ± 0,59 mm, a oko ima jakost od 25,96 ± 1,38 D. Rožnica u ispitivanoj skupini pokazuje tomografska obilježja odrasle rožnice: oblik rožnice je prolatni, a zakrivljenost prednje površine rožnice K1 i K2 iznosi: 42,92 ± 1,29 D i 43,75 ± 1,41 D. Parametri BAD i FA prosječnih su vrijednosti sličnih onima odraslih ispitanika. Zaključak: Studija daje prvu detaljnu normativnu bazu podataka o makularnoj vaskularnoj mreži i optičkim obilježjima oka u najmlađoj uniformnoj kohorti emetropne četverogodišnje djece.Objective: The purpose of this study, which included healthy emetropic four-year-old Caucasian children, was to provide a normative database on perfusion of macular vascular network in 4-year-old children acquired by optical coherence tomography (OCTA) and optical eye parameters by optical biometrics and corneal tomography (KT). Study design: cross-sectional research Patients and Methods: One eye of each subject underwent OCTA, OB, and KT imaging. The following parameters were analyzed using AngioTool Image J software: vessels area (VA), vessels density (VD), the total number of junctions (TNJ), junctions density (JD), total vessel length (TVL), average vessel length (AVL), the total number of endpoints (TNEP), lacunarity (L), vessel diameter index (VDI) and foveal avascular zone (FAZ) area. Built-in OCTA device software generated average macular thickness and volume values. Optical parameters were analyzed by OB. Corneal parameters were obtained by KT using the Belin-Ambrosio Enhanced Ectasia Display (BAD) and Fourier analysis (FA). Results: The study examined 180 eyes of 180 children with an average age of 48 (46–59) months. Macular blood vessels in the fourth year of life demonstrate high density: the highest average VD is in the choriocapillaris (cc) 79.26%, while in the superficial, middle, and deep plexus it measures similar values: 65.16%, 65.67%, and 67.05 %. VA and VD increase from the inner to the outer layers of the retina. Morphological features of the middle capillary plexus in the examined group are presented. Gender differentiation of the retina with respect to sex was supported, i.e., boys recorded significantly larger blood vessel areas compared to girls in most of the observed layers. At the age of 4, the eye has the characteristics of an emetropic eye: AX is 22.14±0.59 mm, and the eye has a strength of 25.96±1.38 D. The cornea in the study group indicates tomographic features of the adult cornea: the shape of the cornea is prolate, and the curvature of the anterior surface of the cornea K1 and K2 are: 42.92±1.29 D and 43.75±1.41 D. The parameters of BAD and FA are average values, similar to those of adult subjects. Conclusion: The study provides the first detailed normative database on macular vascular network and optical features of the eye in the youngest uniform cohort of emmetropic four-year-old children