A comparison of the Grass strobe and new LED photic stimulator for paediatric electroretinogram recordings.

PURPOSE: This study evaluated a new light-emitting diode (LED-S) photic stimulator and compared skin electroretinogram (ERG) responses obtained to those evoked by the Grass Instrument stimulator (GP-S). METHODS: Two sub-studies were combined to evaluate the difference in responses resulting from the LED-S and GP-S stimuli. The first was a photometry study that matched the LED-S stimuli to the GP-S. In the second study, electroretinograms (ERGs) were recorded under scotopic and photopic conditions using stimuli each stimulator. The stimuli were matched photometrically to measurements obtained from the photometer located 30 cm in front of the stimulators. In addition, the ERG responses were recorded from the LED stimulator when photometrically matched to the GP-S blue stimulus presented through a ganzfeld. The amplitudes and time peaks of the resulting ERG a- and b-waves were then measured and compared using paired T-tests. RESULTS: Study 1: The LED-S was matched to the GP-S at various intensity settings measured 30 cm away from the stimulator. Measurement through a ganzfeld full-field stimulator (GFFS) demonstrated that the GP-S had a significant hot spot centrally. Study 2: Photometrically matched ERGs evoked by both stimulators while employing the direct head-on measurements demonstrated multiple similarities. Similarities included component morphology, amplitude and implicit time across the two stimulators, excluding the rod-driven stimulus (GP-S setting employing a blue filter). Differences between the rod-driven ERGs evoked by the GP-S and LED-S while employing head-on photometric measurements were due to the significant difference in intensities between the two stimulators. The GP-S and LED-S evoked similar rod-driven ERG responses when they were matched using the GFFS photometrically matched intensities protocol. CONCLUSION: A hand-held stimulator is essential when recording ERG's in the practice of paediatric visual electrophysiology. The LED-S can match the GP-S stimulus intensities, making it a potential replacement for the GP-S. In addition, the LED-S has uniform intensity across the surface of the device compared to the GP-S, is silent for standard stimuli and can generate prolonged duration stimuli for the recording of on-off ERGs.

Melphalan toxicity following treatment of retinoblastoma identified by pattern electroretinogram.

PURPOSE: To describe a patient with retinoblastoma and subsequent maculopathy unrelated to the tumor but related to intra-arterial melphalan documented by pattern electroretinography. METHODS: Comprehensive ophthalmic evaluation, treatment with intra-arterial chemotherapy and subsequent follow-up including electroretinography to assess for macular dysfunction. RESULTS: A 3-year-old child was evaluated with electrophysiological investigations following treatment of unilateral Group D retinoblastoma with intra-arterial and intravitreal chemotherapy with melphalan. Pattern reversal visual evoked potential amplitude and P100 latency were normal in the left eye, but abnormal and delayed in the right eye. Pattern electroretinograms (pERGs) were abnormal on the right eye. Flash electroretinograms (fERGs) were normal on both eyes. Visual acuity dysfunction of 20/50 attributed to melphalan was seen on the right eye vs 20/40 on the left eye. CONCLUSION: Our case report demonstrates that pERG rather than fERG should be used to monitor baseline macular function and potential toxicity in children undergoing chemotherapy for retinoblastoma using skin electrodes when corneal electrodes are not tolerated.

Developing a pediatric ophthalmology telemedicine program in the COVID-19 crisis.

PURPOSE: To describe our methodology for implementing synchronous telemedicine during the 2019 novel coronavirus (COVID-19) pandemic. METHODS: A retrospective review of outpatient records at a single children's hospital from March 21 to April 10, 2020, was carried out to determine the outcome of already-scheduled face-to-face outpatient appointments. The week leading up to the March 21, all appointments in the study period were categorized as follows: (1) requiring an in-person visit, (2) face-to-face visit that could be postponed, and (3) consultation required but could be virtual. Teams of administrators, schedulers, and ophthalmic technicians used defined scripts and standardized emails to communicate results of categorization to patients. Flowcharts were devised to schedule and implement telemedicine visits. Informational videos were made accessible on social media to prepare patients for the telemedicine experience. Simultaneously our children's hospital launched a pediatric on-demand e-consult service, the data analytics of which could be used to determine how many visits were eye related. RESULTS: A total of 237 virtual ophthalmology consult visits were offered during the study period: 212 were scheduled, and 206 were completed, of which 43 were with new patients and 163 with returning patients. Following the initial virtual visit, another was required on average in 4 weeks by 21 patients; in-person follow-up was required for 170 patients on average 4.6 months after the initial virtual visit. None needed review within 72 hours. The pediatric on-demand service completed 290 visits, of which 25 had eye complaints. CONCLUSIONS: With proper materials, technology, and staffing, a telemedicine strategy based on three patient categories can be rapidly implemented to provide continued patient care during pandemic conditions. In our study cohort, the scheduled clinic e-visits had a low no-show rate (3%), and 8% of the on-demand virtual access for pediatric care was eye related.