AAOpt 2026: A practical guide to pediatric retina

Alongside colleague Denise Skiadopoulos, OD, FAAO, Raman Bhakhri, OD, FAAO, presented a session on pediatric retina at AAOpt 2026 in Anaheim, California. In "Little Eyes, Big Insights: A Practical Guide to Pediatric Retina," Bhakhri said his main points are that retinal disease can affect children too, that clinicians need to get good dilated views and use imaging, and that whether a treatment exists should decide what gets referred out.

What the lecture covered

Bhakhri says retinal problems can affect anyone, children included. The lecture was organized into congenital conditions, hereditary, or inherited conditions that show up later, and infectious and neoplastic (cancer) conditions in young patients.

The biggest misconception

The main problem he sees is getting a good look at the retina in children. Kids dislike being dilated just as adults do. According to Bhakhri, Skiadopoulos shared ways to hold a child's attention during BIO or 90D exams, such as bringing in another clinician or a parent, or using a different target. He also urges clinicians not to assume a child is too young or too small for Optos widefield imaging or optical coherence tomography. "You don't know unless you try," Bhakhri told Optometry Times.

Conditions clinicians are most likely to see

All of these conditions are rare. Still, congenital and hereditary conditions are the ones clinicians will see most often. Infections are uncommon in children, and tumors are very rare. The key is to recognize these conditions and know when and where to refer.

Myopia and retinal risk

As myopia becomes more common, treatments like contact lenses, the newly approved Stellest lenses and atropine drops aim to slow its progression. A longer eye raises the risk of pathological myopia, which in turn raises the risk of macular atrophy, foveoschisis, and retinal detachment linked to lattice degeneration.

When to monitor and when to refer

Bhakhri’s rule of thumb is to ask whether a treatment is actually available, which depends on the following conditions:

• Congenital and hereditary conditions: Most have no treatment. The exception he mentions is a gene therapy for retinitis pigmentosa caused by the RPE65 mutation (the transcript says "RP65"). Optometrists who are comfortable and properly equipped can monitor these patients themselves.
• Suspected cancer: Refer to ocular oncology ASAP.
• Infections: These often point to a wider infection in the body, so bring in infectious disease specialists and retina specialists.

Clinical pearls

Bhakhri closes with 2 takeaways: "dilate your patients" and use imaging as an add-on to dilation, never as a replacement. He adds that every clinician should know at least the basics of pediatric retina and hopes people who attended or watched come away with useful pearls.