Role of visual illusions in the assessment of digital color images of aggressive posterior retinopathy of premature

AIM: To estimate the role of visual illusions in the diagnosis of aggressive posterior retinopathy of prematurity (APROP) using a pediatric retinal camera.

MATERIAL AND METHODS: A retrospective analysis of images of the fundus structures obtained using a pediatric retinal camera was carried out in 31 children diagnosed with APROP. The children were treated at St. Petersburg’s Children’s Hospital N17 of St. Nicholas from January 2011 to December 2018. Based on the analysis of digital colored images of the fundus, the diagnosis of ARN was confirmed in 18 children (58%), and in the remaining 42% of cases (13 children), the diagnosis was revised from APROP to classic ROP (stage 3, with signs of “plus” disease, zones I or II). Preterm infants with classic ROP were excluded from the study group.

RESULTS: A total of 14 out of 18 (78%) children with APROP were initially diagnosed with manifestations of classical ROP. Analysis of colored images obtained with a retinal camera showed that all of them manifested Mach’s bands, which created the effect of a demarcation line or a demarcation ridge at the border of light and dark areas. Although they were manifestations of APROP, these illusions were the reason for the diagnosis of classical ROP along with the designation of stages. The effect of Mach band illusion was neutralized by the study of colored photographs on the monitor screen under high magnification.

CONCLUSION: Visual illusions create difficulties in the timely diagnosis of APROP during the investigation with a retinal camera. They may influence the treatment of patients and lead to poor outcomes of this most severe form of ROP, including the development of retinal detachment and visual impairment in children.