🧪 Purpose of the Study

• Evaluates the diagnostic utility, safety, and administration protocols of Oral Fluorescein Angiography (OFA) in children.
• Compares OFA to Intravenous Fluorescein Angiography (IVFA) in terms of image quality and clinical effectiveness.

📊 Key Findings

• 15 studies included, covering 581 eyes from 464 pediatric patients.
• OFA is less invasive, better tolerated, and has fewer adverse effects than IVFA.
• Most common OFA dose: 25 mg/kg of 10% fluorescein dye, often diluted in juice or soda.
• Adverse reactions were rare (only 0.019% mild cases like nausea or itching).
• OFA provided high-quality diagnostic images for conditions such as:
  • Retinal vasculopathies
  • Uveitis
  • Papilledema vs. pseudopapilledema
  • Coats disease
  • Retinopathy of prematurity

🔬 Comparison with IVFA

• OFA and IVFA showed comparable image quality in most studies.
• OFA was more successful in younger children due to easier administration.
• IVFA had slightly better fluorescence intensity and faster dye appearance but higher risk of adverse events.

🧠 Clinical Implications

• OFA is a viable alternative to IVFA, especially for needle-averse or high-risk pediatric patients.
• Fasting and rapid ingestion improve image quality.
• OFA can be used for routine monitoring and diagnosis in pediatric ophthalmology.

🔬 Oral vs. Intravenous Fluorescein Angiography

• OFA was found to be equivalent or nearly equivalent to IVFA in diagnosing conditions like uveitis, Coats disease, FEVR, and papilledema.

• IVFA had slightly better image sharpness and faster dye circulation, but OFA was more practical in younger age groups

📋 Protocols for OFA Administration

• Rapid ingestion improves dye absorption and image quality.

• Fasting significantly enhances visualization and reduces variability in dye appearance time

🎓 Training and Interpretation

• A study by Brady et al. showed that training improves diagnostic accuracy using OFA images.

• After a tutorial, consultants (attending physicians) had an 81.7% correct diagnosis rate vs. 58.8% for trainees.

• Training focused on identifying features of papilledema, optic nerve head drusen (ONHD), and inflammatory papillitis.

• Results suggest that OFA interpretation can be standardized and taught effectively

🧪 Clinical Implications

• OFA is a safe, effective, and child-friendly alternative to IVFA.

• Particularly useful for:

  • Retinal vasculopathies

  • Uveitis

  • Papilledema vs. pseudopapilledema

  • Coats disease

  • Retinopathy of prematurity

• Standardized protocols and training can enhance adoption and diagnostic consistency.

Ghaleb, R., Sallam, A. B., Grigorian, F., Phillips, P. H., & Elhusseiny, A. M. (2025). Oral fluorescein angiography in pediatric ophthalmology. Survey of Ophthalmology, 70(5), 849–858. https://doi.org/10.1016/j.survophthal.2025.03.005

🧠 Podcast Overview

• The episode features Dr. Neema Patel discussing her team’s study on adverse events in pediatric fluorescein angiography (FA), comparing intravenous (IV) vs oral administration.
• Hosted by Dr. Edmund Tsui for the Ophthalmology Journal podcast, affiliated with the American Academy of Ophthalmology.

📊 Study Highlights

• Setting: Boston Children’s Hospital with a multidisciplinary team including fellows, residents, and nurses.
• Motivation: Nurses observed frequent IV-related issues, prompting a deeper look into real-time adverse events.
• Methodology: Retrospective review of a prospectively maintained database tracking FA-related complications.

⚠️ Key Findings

• Total visits: 258 pediatric FA procedures.
• Adverse events: 35% overall; IV group had 39% vs oral group’s 9%.
• Common IV issues: Pain (10%), failed cannulation (10%), nausea (low), vomiting, hives, and fainting.
• Oral FA: Fewer complications, but taste was a common complaint.

🧒 Pediatric Considerations

• Children are less tolerant of IV procedures; parental concern is higher.
• Oral FA is often sufficient for conditions like sickle cell disease and Coats disease, though IV may still be preferred for uveitis due to leakage assessment.

🛠️ Practice Implications

• Shift toward oral FA as default in many cases.
• Tips include mixing fluorescein with apple juice, scheduling FA on follow-up visits, and hydrating before IV FA.
• Suggests future research comparing image quality between oral and IV FA.

Oral vs Intravenous Fluorescein Angiography Quiz