April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Pediatric Teleophthalmology Diabetes Eye Care Program in Caracas, Venezuela: Joslin Vision Network 7 Year Experience
Author Affiliations & Notes
  • Emily K Deschler
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Kristen Hock
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Department of Ophthalmology, Harvard Medical School, Boston, MA
  • Jerry Cavallerano
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Department of Ophthalmology, Harvard Medical School, Boston, MA
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Department of Ophthalmology, Harvard Medical School, Boston, MA
  • Morella M Grossmann
    MMG Fundación, Caraces, Venezuela, Bolivarian Republic of
  • Andreina Millan
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
  • Lloyd M Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Department of Ophthalmology, Harvard Medical School, Boston, MA
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
    Department of Ophthalmology, Harvard Medical School, Boston, MA
  • Footnotes
    Commercial Relationships Emily Deschler, None; Kristen Hock, None; Paolo Silva, None; Jerry Cavallerano, None; Jennifer Sun, None; Morella Grossmann, None; Andreina Millan, None; Lloyd Aiello, None; Lloyd Aiello, Optos (R)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 2289. doi:
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    • Get Citation

      Emily K Deschler, Kristen Hock, Paolo Sandico Silva, Jerry Cavallerano, Jennifer K Sun, Morella M Grossmann, Andreina Millan, Lloyd M Aiello, Lloyd P Aiello, ; Pediatric Teleophthalmology Diabetes Eye Care Program in Caracas, Venezuela: Joslin Vision Network 7 Year Experience. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2289.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To assess the presence, onset and progression of diabetic retinopathy (DR) in a type 1 pediatric diabetes population in Caracas, Venezuela as evaluated in the Joslin Vision Network (JVN) teleophthalmology diabetes eye care program.

Methods: Stereoscopic nonmydriatic digital retinal imaging (3x45° fields, 2x30° fields & external image of each eye) was obtained from patients presenting for routine care at the pediatric endocrinology clinic at the Hospital de Niños, Caracas, Venezuela. Image grading for clinical level of DR and diabetic macular edema (DME) was performed remotely by certified graders using the previously validated JVN protocol.

Results: From 11/2006 to 10/2013, 480 patients ≤ 18 years of age with type 1 DM were imaged. At initial imaging, (mean±SD) age was 10.6±3.7 years, DM duration 2.7±3.4 years, age at DM diagnosis 7.9±3.8 years and 54.4% were female. Baseline A1C was obtained in 66.3% (N=318). Mean A1C was 9.8±2.5% (range 4.4-17.7%) and was >8.0% in 74.5% (237). This program was the patient’s first exposure to eye care in 44.2% (212). DR was present at baseline in 5.2% (23 patients with mild nonproliferative DR (NPDR), 1 moderate NPDR, and 1 proliferative DR). Images were ungradable in 1.3% (6). Follow-up imaging was performed for 283 (59.0%) patients over an average of 2.6±1.9 imaging sessions and follow-up of 1.15±0.67 years. A ≥ 2 step DR progression was observed in 5.2% (29/558) of eyes with gradable images. Among the 264 (93.3%) patients with no DR on initial imaging, 37 (14.0%) developed DR and 2 (0.8%) developed proliferative DR during followup. Age >12 years (OR 4.1, 95% CI 1.7-9.7, p=0.001), DM duration > 5 years (2.8, 1.2-6.5, p=0.019) and DM onset <12 years (5.9, 1.5-23.7, p=0.013) were associated with an increased risk for onset and progression of DR.

Conclusions: Retinal imaging can be effectively obtained (99% gradable) in an underserved pediatric population and readily identifies a substantial amount of DR. In this cohort, DR was present in over 5% at baseline. Remarkably, over a mean followup of less than 14 months, 14% developed new onset DR and over 5% had ≥ 2 step DR progression. These data reinforce the critical need for medical and ophthalmic care and education to reduce the risk of DR progression, and suggest that teleophthalmology programs may serve a useful role in assessing and following DR in pediatric diabetes populations.

Keywords: 499 diabetic retinopathy • 461 clinical (human) or epidemiologic studies: natural history • 550 imaging/image analysis: clinical  
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