What is Paediatric Retina?
Paediatric Retina is a specialized field that focuses on diagnosing and treating retinal disorders in infants and children. It includes conditions like retinopathy of prematurity, inherited retinal diseases, and other vision-threatening issues affecting the developing retina.
What is Paediatric Retina?
Paediatric Retina is a specialized field that focuses on diagnosing and treating retinal disorders in infants and children. It includes conditions like retinopathy of prematurity, inherited retinal diseases, and other vision-threatening issues affecting the developing retina.
Paediatric Retina in India – Understanding the Conditions and Treatment
Paediatric retina is the subspecialty of ophthalmology concerned with the diagnosis and management of diseases affecting the retina and vitreous in children – from premature neonates through adolescents. The retina is the light-sensitive layer lining the back of the eye; it converts light into electrical signals transmitted to the brain via the optic nerve. Retinal disease in children is distinct from adult retinal disease in its causes, clinical presentation, and management challenges – not least because children often cannot communicate visual symptoms and may conceal significant visual loss through compensatory behaviour.
Paediatric retinal conditions range from conditions present at birth (congenital retinal dystrophies, Leber congenital amaurosis) to those that develop in the neonatal period (retinopathy of prematurity), conditions related to systemic disease (diabetic retinopathy in adolescents, sickle cell retinopathy), trauma-related retinal injuries (including non-accidental injury), and tumours (retinoblastoma). Management requires expertise in both paediatric ophthalmology and vitreoretinal surgery, with access to appropriate anaesthetic support for procedures in young children.
Vasan Eye Care’s paediatric retina service provides screening, diagnostic evaluation, laser treatment, anti-VEGF therapy, and surgical management of retinal conditions in children, including a dedicated retinopathy of prematurity (ROP) screening programme.
Retinal conditions in children represent a significant cause of childhood visual impairment and blindness in India. Retinopathy of prematurity (ROP) is a leading and preventable cause of childhood blindness, driven by India’s high rate of premature births and variable quality of neonatal oxygen monitoring across different levels of neonatal care. Retinoblastoma – the most common intraocular malignancy in children – affects approximately 1,500 Indian children annually, with many presenting at advanced stages due to delayed diagnosis.
Inherited retinal dystrophies (Leber congenital amaurosis, retinitis pigmentosa in children) are seen across India, with a higher prevalence in communities practising consanguineous marriage. Non-accidental injury (abusive head trauma) presents with bilateral retinal haemorrhages in infants and requires careful ophthalmological documentation as part of the child protection evaluation. Vasan Eye Care’s paediatric retina team is equipped to manage all these presentations with appropriate clinical expertise.
Paediatric Retinal Conditions
| Condition | Age of Presentation | Key Management |
|---|---|---|
| Retinopathy of Prematurity (ROP) | Premature neonates (4-6 weeks postnatal) | Laser photocoagulation; anti-VEGF injection; vitreoretinal surgery |
| Retinoblastoma | Under 5 years; typically 1-3 years | Intra-arterial chemotherapy; intravitreal chemo; laser; cryotherapy; enucleation |
| Leber Congenital Amaurosis (LCA) | Birth to 1 year | Low vision rehabilitation; genetic testing; gene therapy (for RPE65 mutation) |
| Retinitis Pigmentosa (childhood-onset) | First decade | Low vision; UV protection; genetic counselling; clinical trials |
| Familial Exudative Vitreoretinopathy (FEVR) | Any age; often neonatal | Laser; cryotherapy; vitreoretinal surgery |
| Coat’s Disease | School age; predominantly boys | Laser; cryotherapy; anti-VEGF; vitreoretinal surgery |
| Persistent Fetal Vasculature (PFV) | Birth | Surgery; amblyopia treatment |
| Traumatic retinal injury / Non-accidental injury | Infants; any child | Documentation; vitreoretinal surgery if detachment; child protection referral |
Paediatric Retina: How Diagnosis Works
Diagnosing retinal conditions in young children requires examination techniques adapted to the paediatric setting. Infants and toddlers cannot cooperate with slit-lamp biomicroscopy or optical coherence tomography (OCT) in the way adults can. Indirect ophthalmoscopy – using a headband-mounted light source and condensing lens – allows examination of the retinal periphery and is the standard method for ROP screening and retinoblastoma evaluation. Examination under anaesthesia (EUA) is performed for children who cannot cooperate with the examination or in whom a detailed assessment including biometry, tonometry, and scleral indentation is required.
Retcam imaging – wide-field retinal photography designed specifically for infants – provides a permanent, shareable record of retinal findings and is used in ROP documentation and retinoblastoma staging. Wide-field OCT systems capable of imaging infants under anaesthesia are now available at specialised centres. Electroretinography (ERG) is used to assess retinal function in children with suspected inherited retinal dystrophies or unexplained visual loss.
When Should a Child Be Assessed for Retinal Disease?
- Premature birth (below 32 weeks gestation or below 1,500 g birth weight) – mandatory ROP screening
- White reflex (leucocoria) in one or both eyes – urgent evaluation for retinoblastoma or other causes
- Strabismus (squint) of sudden onset in a young child – retinoblastoma can present this way
- Nystagmus from early infancy – may indicate a severe congenital retinal disorder
- Night blindness in a child – possible inherited retinal dystrophy
- Poor visual response from birth – possible LCA or other congenital retinal disorder
- Retinal haemorrhages in an infant without a clear explanation – requires urgent evaluation and child protection assessment
- Family history of retinoblastoma or inherited retinal disease
Paediatric Retina Management – Step-by-Step
- Clinical assessment: Age-appropriate visual acuity; pupil reactions; external examination; indirect ophthalmoscopy.
- Examination under anaesthesia (EUA): For infants and young children requiring detailed retinal examination, intraocular pressure measurement, or biopsy.
- Imaging: Retcam wide-field photography; wide-field OCT; fluorescein angiography under anaesthesia where indicated; B-scan ultrasound for opaque media.
- Electrophysiology: ERG for suspected retinal dystrophies; visual evoked potentials (VEP) for optic nerve and cortical assessment.
- Genetic testing: For inherited retinal dystrophies – NGS panel testing for LCA, RP, FEVR gene mutations.
- Treatment: Laser photocoagulation or anti-VEGF for ROP and Coat’s disease; chemotherapy protocols for retinoblastoma; vitreoretinal surgery for retinal detachment; gene therapy referral for eligible LCA patients.
- Visual rehabilitation: Low vision aids and support for children with permanent visual impairment; school support coordination.
- Long-term monitoring: Regular follow-up for disease progression, treatment response, and visual development.
How Much Does Paediatric Retina Treatment Cost in India?
| Service | Approximate Cost Range (INR) |
|---|---|
| ROP screening (bedside / clinic) | ₹2,000 – ₹6,000 |
| ROP laser treatment (both eyes, under GA) | ₹20,000 – ₹60,000 |
| Intravitreal anti-VEGF injection (per eye, per session) | ₹15,000 – ₹40,000 |
| Examination under anaesthesia (EUA) | ₹8,000 – ₹20,000 |
| Vitreoretinal surgery (retinal detachment) | ₹60,000 – ₹2,00,000 |
| ERG / Retcam imaging | ₹3,000 – ₹10,000 |
Retinoblastoma management costs vary significantly by treatment protocol. Contact Vasan Eye Care for information on available services and referral pathways.
Paediatric Retina Post-Treatment Care and Recovery
What to Expect After Paediatric Retina Treatment?
After laser treatment for ROP, the retinas are re-examined at 1-2 week intervals to confirm regression of the abnormal vessels and stability of the retina. Anti-VEGF injections for ROP are effective rapidly but require careful follow-up because the effect is temporary, and recurrence of vessel growth can occur. Vitreoretinal surgery for retinal detachment in children is technically challenging and visual outcomes are variable, particularly in ROP-related detachment where the retina may be significantly tented or folded.
For children with retinoblastoma managed with globe-preserving therapy, regular examinations under anaesthesia are performed at intervals of 4-6 weeks during active treatment and thereafter at 3-6 monthly intervals as the tumours regress into calcified scars.
Post-Treatment Care Tips
- Maintain all scheduled follow-up appointments – the treatment of paediatric retinal conditions requires close, ongoing surveillance
- For ROP-treated children: continue regular ophthalmology follow-up beyond the neonatal period – these children have a higher lifetime risk of myopia, strabismus, and amblyopia
- For retinoblastoma families: siblings and children of affected individuals require genetic counselling and screening
- Enrol with low vision rehabilitation services early for children with irreversible visual impairment
- Communicate with the child’s school to arrange appropriate educational support and accommodations
- Stay informed about clinical trial opportunities for inherited retinal dystrophies – eligibility is determined by genetic mutation type
References
- American Academy of Ophthalmology. Retinopathy of Prematurity. https://www.aao.org/eye-health/diseases/retinopathy-of-prematurity
- PMC – NCBI. Retinoblastoma: An Overview. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9012867/
- National Eye Institute. Retinopathy of Prematurity. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinopathy-of-prematurity
Frequently Asked Questions
ROP is an abnormal proliferation of retinal blood vessels in premature infants, driven by fluctuations in oxygen levels during neonatal care. It can progress to retinal detachment and blindness if untreated. All infants born before 32 weeks gestation or weighing under 1,500 g require systematic ROP screening, as do larger infants with an unstable clinical course.
Leucocoria is a white or whitish appearance in the pupil – seen in photographs as a white glow instead of the normal red-eye reflex. It is the most common presenting sign of retinoblastoma and can also indicate cataract, persistent fetal vasculature, or other serious retinal disease. Any child with leucocoria should be evaluated by an ophthalmologist urgently.
Yes, in many cases. Intra-arterial chemotherapy (chemotherapy delivered directly to the eye’s blood supply via catheterisation) has transformed retinoblastoma management, allowing globe salvage in eyes that previously would have required enucleation. Intravitreal chemotherapy, laser photocoagulation, and cryotherapy are used for focal tumours. Enucleation (removal of the eye) is required when tumours are too extensive for conservative treatment or when there is risk of metastasis.
LCA is a severe inherited retinal dystrophy causing profound visual impairment from birth or early infancy. Children may have nystagmus, poor fixation, and press their eyes with their knuckles (oculodigital sign). It is caused by mutations in multiple genes. For the most common form (RPE65-associated LCA), a gene therapy (Luxturna/voretigene neparvovec) is approved and can restore meaningful vision in eligible patients.
Coat’s disease is a non-hereditary retinal vascular disorder characterised by abnormal, leaking retinal blood vessels that deposit lipid (cholesterol) exudates in and under the retina. It predominantly affects boys in the first decade of life and can cause leucocoria and severe visual loss if untreated. Treatment involves laser photocoagulation and cryotherapy to ablate the abnormal vessels, and sometimes anti-VEGF injections or vitreoretinal surgery.
Yes. Bilateral multi-layered retinal haemorrhages extending to the periphery in an infant – without a clear history of severe trauma – are strongly associated with abusive head trauma (shaken baby syndrome). Ophthalmological documentation of the haemorrhages is an important part of the medical evaluation. This requires a sensitive, collaborative approach with paediatrics and child protection teams.
FEVR is an inherited retinal vascular disorder in which peripheral retinal vascularisation is incomplete, leading to retinal ischaemia, neovascularisation, exudation, and retinal detachment. It resembles ROP but occurs in full-term infants and older children. It is caused by mutations in several genes and can range from asymptomatic to severely vision-impairing.
Low vision rehabilitation for children includes assessment with specialist low vision aids (magnifiers, screen readers), guidance for school accommodation (large print, front seating, assistive technology), orientation and mobility training, and coordination with educational psychologists and special needs educators. Early enrolment with these services – before vision loss becomes severe – yields the best results.
After ROP laser treatment, the retina is examined every 1-2 weeks until confirmed stable. Once stable, annual or biannual follow-up is recommended throughout childhood for surveillance of myopia, strabismus, amblyopia, and late retinal detachment – all of which occur at higher rates in premature infants, whether or not they had ROP.
Yes. Vasan Eye Care provides paediatric retina services including ROP screening and treatment, retinoblastoma evaluation, inherited retinal disease assessment with ERG and genetic testing, and vitreoretinal surgical management of retinal detachment in children.
References
