Off-axis nonmydriatic photography to evaluate the posterior pole through small pupils.

PURPOSE: The purpose of this study was to improve the clarity of retinal images photographed through small pupils. METHODS: Retinal photographs were taken with a Topcon TRC-NW100 digital nonmydriatic camera centered and decentered about the pupillary axis. Four hundred and twelve consecutive individuals (age, 8-95 years) were screened for eye disease with nonmydriatic retinal photography in the District 33N Lions Eyemobile during a 1-year period. RESULTS: Twenty-nine percent of the eyes photographed had pupillary diameters <4 mm and yielded or would have yielded poor-quality images of the posterior pole with standard, on-axis alignment. In 78% of these eyes with small pupils, photography with off-axis alignment produced images of sufficient clarity for clinical assessment of retinal appearance. CONCLUSION: Off-axis alignment increases the percentage of gradable images of the posterior pole in individuals with small pupils.