Source:Pediatric Neurology
Author(s): Michael M.H. Yang, Ash Singhal, Alexander R. Hengel, John M. Kerr, Godefroy Hardy St-Pierre, Shawn George, Katherine Muir, Paul Thiessen, Paul Enarson
BackgroundFundoscopy is an important component of the neurological examination as it can detect pathologies such as high intracranial pressure. However, the exam can be challenging in young children. This study evaluated whether playing a video during eye examination improves the success, duration and ease of pediatric fundoscopy.Study DesignThis was a prospective, multi-practitioner, multi-clinic, randomized controlled trial. Patients 1-4 years of age were recruited in the emergency department, neurology clinic, spinal cord clinic and general pediatric clinic. Eye examination was randomized to video/non-video assisted fundoscopy. Successful exams were defined as visualizing the fundus within 60 seconds. Time to visualize optic disc was recorded and difficulty of exam was assessed using a 10-point Likert scale by the practitioner and the caregiver.ResultsOne-hundred-one subjects were recruited, with a mean age of 2.8 years. Overall, there was a 20% absolute improvement in the success rate of visualizing the optic disc in the video versus non-video group (p<0.001, 95% CI: 7.8-31%). Time to visualize optic disc was also improved (Δ5.3s, p<0.01, 95% CI: 1.4-9.1s). Practitioners and caregivers noticed a 33% (p<0.01, 95% CI: 21-44%) and 42% (p<0.01, 95% CI 30-56%) relative improvement in the ease of exam with video respectively.ConclusionVideo improved the ease, duration and most importantly the success of fundoscopy in younger children. This simple, inexpensive adjunct has great potential to improve the ease and efficacy of this aspect of the neurological examination and allowing fundoscopic examination to be effectively performed earlier in the age-appropriate vision screening protocols.
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