Pediatric patients recovering from COVID-19 frequently experience an increase in retinal vessel density (VD), increased macular perfusion density (mPD), and a higher flux index (FI) of peripapillary optical coherence tomography angiography (OCT-A), according to a study published in the Journal of American Association for Pediatric Ophthalmology and Strabismus. 

Researchers included 72 children between the ages of 6 and 18 years who recovered from COVID-19 (n=27) and a healthy control group (n=45). They administered an ophthalmic examination to all participants and noted no instances of retinal hemorrhages, cotton wool spots, or other retinal abnormalities in any of the patients. Mean time from COVID-19 diagnosis to the date of the exam was 37.6±12.9 days.

Unlike the routine ophthalmic exam, the OCT-A analysis revealed significant differences between the recovering COVID-19 patients and the control group. The recovery group experienced increased mPD in the inner ring, along with higher VD (both P =.001). Similarly, peripapillary OCT-A revealed a higher FI in all 4 quadrants in recovering patients compared with the control group (P <.001). 

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“Previous research has reported a reduction in retinal VD and other vascular parameters of OCT-A in adults with SARS-CoV-2 infection,” according to investigators. “On the contrary, our study indicates that children recovered from COVID-19 have significantly greater macular VD and mPD and peripapillary FI than healthy children. The reason for this paradoxical response in children is not precisely understood, although the apparent differences in immune response to SARS-CoV-2 infection and the anatomical and structural differences between the adult and pediatric retina might partially account for these findings.”

Study limitations include a small sample size, single center design, and the inability to perform assessments during the acute phase of COVID-19 infection. 


Guemes-Villahoz N, Burgos-Blasco B, Perez-Garcia P, et al. Retinal and peripapillary vessel density increase in recovered COVID-19 children by optical coherence tomography angiography. J AAPOS. 2021;25(6):325.E1-325.E6 doi:10.1016/j.jaapos.2021.06.004