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Jeffrey Tapley, Gerald McGwin, Ambika Ashraf, Paul MacLennan, Koula Callahan, Karen Searcey, C. Douglas Witherspoon, Jinan Saaddine, Cynthia Owsley; Feasibility and Efficacy of Diabetic Retinopathy Screening Among Children with Diabetes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5334.
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To determine the feasibility and efficacy of the use of a non-mydriatic camera to screen for diabetic retinopathy (DR) among children with type 1 or type 2 diabetes mellitus. Recent work shows that only two-thirds of diabetic children receive an annual dilated eye exam, making it the least commonly followed of the American Diabetes Association guidelines for diabetes care in children. Non-mydriatic fundus cameras have been implemented as successful screening tools for DR in adults. These cameras are non-invasive, painless, and produce high-quality fundus photographs capable of detecting most clinically significant cases of DR. However, this approach has not been well studied in children.
Children with type 1 or 2 diabetes ages 8 to 18 years old who visited the UAB Pediatric Endocrinology Clinic for a routine appointment were invited to enroll. A non-mydriatic camera (Nidek Model AFC-230) was used to obtain fundus images of each eye. Walk-in visual acuity was assessed with a Titmus vision screener. A brief questionnaire was administered to the parent/guardian addressing the child’s diabetes and previous eye care utilization. Screening took place over an 8-week period. Fundus images were reviewed and graded by a retina specialist using the UK National Health Classification System for DR.
A total of 236 patients were screened; average age was 14.1 years (SD 2.69), 135 (57.2%) were female, and 158 (67.0%) were Caucasian and 70 (29.7%) African American. Most of the patients had type 1 diabetes (85.6%) and average duration since diabetes diagnosis was 5½ years. Only 57 (24.2%) had 20/20 vision in both eyes and 156 (66.1%) reported having had a dilated eye examination within the previous year. Overall, DR was detected in 9 patients (3.8%), i.e., 7 patients had at least 1 eye graded as having background DR (a single eye for 6 and both eyes for 1); whereas 2 patients were graded as having proliferative DR in both eyes. Overall, 23 (9.7%) patients were referred to an ophthalmologist or other eye care provider.
This study shows the use of a non-mydriatic fundus camera is a feasible and efficacious method to screen for DR in children with diabetes. Screening programs may be beneficial in the management of diabetes in children and prevention of irreversible vision loss.
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