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Melissa A. Simon, Ben Szirth, Khadija S. Shahid, Albert S. Khouri; Feasibility Of Telemedicine Retinal Screening In Children With Type I Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2012;53(14):792.
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Diabetic retinopathy is the leading cause of blindness in young adults. The purpose of this study is to demonstrate the feasibility of teleocular screening in a pediatric population with type 1 diabetes (DMI).
Data collected at a single screening convention in Orlando, FL, between June 29 and July 2, 2010 were reviewed. All subjects were ≤17 years with a known diagnosis of DMI. Images were captured by a Canon CX-1, a mydriatic and non-mydriatic 45 degree retinal camera. All subjects were imaged without the use of mydriatic agents and had two images captured of each eye. The first image was captured using a flash setting of 60 watts/second followed by an autofluorescent image at a flash setting of 300 watts/second. Canon proprietary software EyeScape (Canon, Los Angeles, CA) was used to manage all Digital Imaging and Communications in Medicine (DICOM) based images. The resolution of the images was 15.1 megapixels on a complementary metal-oxide semiconductor (CMOS) medical grade image sensor. Additional data collected included: Age, sex, race, duration of diabetes, time since most recent eye exam, type of insulin therapy, and body mass index (BMI).
104 subjects met inclusion criteria for analysis. Non-mydriatic fundus imaging was possible in all subjects. Mean age was 11 yrs (standard deviation 3.8 yrs, range 2-17 yrs). 51 percent were male, 49 percent female. 92 percent of subjects were Caucasian. Mean duration of DMI was 4.97 years (standard deviation 3.49 years, range 4 months-14 years). One subject was found to have diabetic retinopathy at screening (age 15, disease duration 10 years), and three subjects had incidental findings (1 choroidal nevus, 1 cup to disc asymmetry, 1 myopic fundus). Of the 92 subjects with data on their most recent eye exam, 62% had an eye exam <1 yr prior to screening, 29.3% had an exam within 1-2 yrs, and 8.7% had an exam >2 yrs prior to screening. 22 subjects were on an insulin pump, for an average 3.5 years. Mean BMI was 19.8 (standard deviation 3.4).
Screening a pediatric type I diabetic population with telemedicine fundus imaging is feasible. Our study population had characteristics consistent with those for patients recommended to be screened by the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology.
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