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Oral fluorescein angiography in the diagnosis of paediatric optic nerve abnormalities

Eye (2024)Cite this article

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Abstract

Objective

FFA is a well-established investigation for the diagnosis of optic nerve abnormalities, requiring an intravenous cannula and extended imaging acquisition time. Cannulation can present a challenge in paediatric patients and whilst oral FFA has been used for decades, it has been limited by imaging technology and unconfirmed image acquisition timings. For years, we have used a modern ultra-widefield retinal camera, and established imaging time-points to demonstrate dynamic optic nerve head changes upon ingestion of fluorescein and collected a database of oFFA images for various presentations.

Methods

Using an established protocol, optic nerve colour images were obtained, followed by oral administration of fluorescein dye. The optic nerves are then imaged at established intervals. An interpretation of oFFA tutorial was delivered to consultant ophthalmologists and trainees. Subsequently, these groups were assessed using a series of fifteen cases with the sensitivity and specificity of the test determined.

Results

Our study presents a series of images and descriptions for common optic nerve abnormalities in paediatric populations. In the interpretation part of the study, overall sensitivity of 76.8% in the consultant group vs 63.3% in the combined consultant + trainees and specificity of 87.5% vs 68.4% in the combined group.

Conclusions

This is the first study that describes characteristic features of several common, and serious, optic nerve abnormalities specifically for oFFA interpretation in a paediatric population. It also highlights the rapid accumulation of oFFA interpretation skills in non-specialist consultant and trainee ophthalmologists such as to obtain a high diagnostic accuracy with high sensitivity and specificity.

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Fig. 1: Pathway to completing an oFFA investigation.
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Data availability

Raw data can be found at the following link: https://docs.google.com/spreadsheets/d/1ObgRNw3I8aDclxzfnttRjFC-mGEP3X4bwVuHXH8btak/edit#gid=0.

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Acknowledgements

The authors would like to acknowledge the paediatric nursing team and imaging technician team at Addenbrooke’s hospital for their support in completing the oFFA investigations described above. We would also like to acknowledge the participation of consultant and trainees colleagues who engaged in the study.

Funding

The authors did not receive any additional financial resources for completion of this work.

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Authors and Affiliations

  1. Department of Ophthalmology, Addenbrooke’s Hospital, Cambridge, UK

    Robert Thomas Brady, Hrishikesh Kaza, Nikhil Jain & Brinda Muthusamy

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  1. Robert Thomas Brady
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  2. Hrishikesh Kaza
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  3. Nikhil Jain
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  4. Brinda Muthusamy
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Contributions

The authors confirm contribution to the paper as follows: study conception and design: RTB; data collection: RTB, BM; analysis and interpretation of results: HK, RTB, BM; draft manuscript preparation: RTB, BM, HK, NJ. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Brinda Muthusamy.

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The authors declare no competing interests.

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Brady, R.T., Kaza, H., Jain, N. et al. Oral fluorescein angiography in the diagnosis of paediatric optic nerve abnormalities. Eye (2024). https://doi.org/10.1038/s41433-024-02956-y

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