Peripheral retinal abnormalities were frequently detected during routine dilated eye examinations in pediatric patients, with pathological findings occurring more often among those with at least 3.00 D of myopia, according to a retrospective cross-sectional study published in Optometry and Vision Science.

Researchers reviewed records from 874 patients aged 6 to 17 years who underwent routine eye examinations with dilation at The Eye Center at Southern College of Optometry in Memphis, Tennessee, from January 1, 2020, to July 31, 2023. Eligible examinations had to include adequate peripheral retinal documentation and be completed by one of two investigator optometrists.

Patients were categorized according to spherical equivalent refractive error in the more myopic eye as having no myopia, low myopia, or moderate-to-high myopia, defined as at least 3.00 D of myopia.

Overall, 20.2% of patients had at least one abnormal peripheral retinal finding, while 6.3% had at least one pathological finding. At the eye level, 14.4% of eyes had abnormal peripheral retinal findings and 4.2% had pathological findings. White without pressure was the most common abnormal finding, occurring in 11.9% of patients, and lattice degeneration was the most common pathological finding, occurring in 4.5%.

The investigators classified pathological findings as lattice degeneration, atrophic retinal hole, retinal tear, retinal detachment, choroidal nevus, and vitreous tuft. Nonpathological findings included white without pressure, congenital hypertrophy of the retinal pigment epithelium, dark without pressure, retinal pigment epithelium hyperplasia, and window defects.

Rates increased with myopia severity. Among patients with moderate-to-high myopia, 44.8% had at least one abnormal peripheral retinal finding and 17.7% had at least one pathological finding, compared with 8.0% and 1.8%, respectively, among patients without myopia.

In exploratory analyses that were unadjusted for multiple comparisons, patients with moderate-to-high myopia had 11.5 times the odds of retinal pathology detection compared with patients without myopia, although the findings should be interpreted as hypothesis-generating rather than definitive risk estimates. Low myopia was associated with higher odds of abnormal retinal findings compared with no myopia, although pathology rates did not differ significantly between those groups in the primary analysis.

Older age was also associated with retinal findings and pathology. Patients with abnormal retinal findings had a mean age of 12.6 years compared with 10.8 years among those without findings, while patients with pathology had a mean age of 12.9 years compared with 11.0 years among those without pathology.

Race did not appear to be statistically significantly associated with retinal pathology frequency in the predominantly Black cohort. However, the researchers noted that ethnicity data were incompletely captured, limiting subgroup interpretation among Hispanic or Latino patients.

The study also addressed ongoing debate regarding dilation practices in pediatric eye care. Current American Optometric Association pediatric guidelines support dilation during posterior segment assessment but do not specify examination frequency or define risk-based dilation intervals for myopia.

The researchers noted that peripheral findings identified in the study may not have been detected with undilated examinations alone. They also suggested that wide-field retinal photography may serve as an adjunctive tool in pediatric patients with limited cooperation, although indirect dilated fundus examination may better identify peripheral pathology.

“Peripheral retinal pathology is more common in pediatric patients with 3 or more diopters of spherical equivalent myopia, and present across all refractive error statuses,” wrote Morgan C. Ollinger, of Southern College of Optometry in Memphis, Tennessee, and colleagues.

The investigators cautioned that the study’s retrospective cross-sectional design precludes causal conclusions and limits assessment of progression risk. Additional limitations included the single-center setting, reliance on refractive error from final prescription rather than retinoscopy or autorefraction, lack of adjustment for multiple comparisons, and use of a single reviewer for data abstraction.

The researchers also performed a sensitivity analysis reclassifying isolated retinal pigment epithelium hyperplasia as pathological rather than nonpathological. In that analysis, low myopia was associated with significantly higher odds of retinal pathology compared with no myopia, suggesting that classification differences may influence interpretation of lower-risk refractive groups.

The findings suggest that pediatric patients with at least 3.00 D of myopia may warrant particular attention to dilated peripheral retinal evaluation during routine eye care, given the relatively high frequency of pathological findings identified in this group. However, the detection of abnormalities across all refractive categories also suggests that peripheral retinal findings are not limited to myopic patients alone.

Disclosures: The study received logistical and financial support from Southern College of Optometry. Ollinger reported institutional research funding from CooperVision outside the submitted work. Marie I. Bodack reported institutional research funding from Hoya Vision Care outside the submitted work. Morgan I. Bromley reported no relevant conflicts of interest.

Source: Optometry and Vision Science