Polly A Quiram, MD, PhD (Royal Oak, MI), Kimberly A Drenser, MD (Royal Oak, CA), Meng- Chao Chou, MD (Taipei City, Taiwan, China), Antonio Capone, MD (Royal Oak, MI), Michael T. Trese, MD (Royal Oak, MI)


Postnatal development of the fovea and foveal avascular zone (FAZ) is poorly understood in full term and premature infants. Normal foveal development requires key structural alterations such as formation of the perifoveal capillary net and development of the foveal depression both of which we can assess by fluorescein angiography (FA) and optical coherence tomography (OCT) in infants.


An institutionally approved protocol was designed to enroll pediatric patients (less than 5 years of age) who were undergoing examination under anesthesia for pediatric vitreoretinopathies, retinopathy of prematurity or screening examination for known familial retinal disease. Participants underwent a comprehensive ophthalmic exam, fundus photography, FA and OCT.


We have evaluated five infants with poor vision and apparently normal peripheral retinal vasculature and grossly normal posterior pole. Detailed evaluation of the fovea by FA and OCT reveals an abnormal configuration of the FAZ and foveal depression. We have also noted that the visual acuity of premature infants correlates with appropriate FAZ development. Further analysis of this database may allow us to detect changes in the retina that precede formation of the foveal depression including the temporal relationship between the development of the perifoveal vasculature and the foveal depression.


We have observed normal development of the peripheral retinal without subsequent formation of a foveal avascular zone, leading to poor visual acuity in some premature infants. Using our normative database documenting foveal development in normal infants we hope to identify structural markers which may predict normal or abnormal visual development in premature infants.