Lara C. Pullen, PhD

November 10, 2014

CHICAGO — Nonmydriatic imaging could be a helpful addition to the standard clinical examination of children with type 1 diabetes mellitus, a new study shows.

"It is definitely a quicker way of screening a large number of kids," Anton Kolomeyer, MD, from the University of Pittsburgh Medical Center, said here at the American Academy of Ophthalmology 2014 Annual Meeting.

The fundus of 106 children 2 to 17 years of age was photographed using a Canon CX-1 retinal camera. The screenings were done as a special project at Disney World.

Dr Kolomeyer and his team were able to obtain images for 98% of the children. One had nonproliferative diabetic retinopathy and two had incidental findings.

The investigators captured high-quality images for most of the eyes (86.0%), and images of clinical value were captured for 99.5% of the eyes. They calculated an image quality interobserver agreement of 0.896.

Most of the children (62%) had an eye exam in the previous year. However, a recent eye exam was more common in children with newly diagnosed diabetes (in the previous 3 years) than in those with an older diagnosis (41% vs 36%; P = 0.66). A recent exam was also more common in children diagnosed in the previous 5 years than in those with an older diagnosis (49% vs 27%; P = .03).

Children are being diagnosed with diabetes at a younger and younger age, which means that eye exams become medically important at a younger and younger age. The traditional approach to screening these children is time-consuming and unpleasant.

Photographing the Fundus

Dr Kolomeyer described his experience screening children: "I just came off of 8 weeks of giving kids drops. It is really, really crazy."

He said he was surprised that most of the children in the study behaved very well. "If you put them with their age groups, they are more likely to be compliant," he explained.

"If this could be done in an endocrinologist's office without dilation, it could be helpful," explained Martha Schatz, MD, from University of Texas Medicine in San Antonio. She also pointed out that nondilation is a hot topic in adults and has been discussed for many years.

This work builds on previous research where investigators found that adequate nonmydriatic fundus photographs can be obtained in children older than 3 years of age (J AAPOS. 2011;15:567-572). They suggest that the photographs can serve as an alternative to pediatric ophthalmologic visits. They also say that it might be possible for the pediatrician to take the photographs.

Dr Kolomeyer and Dr Schatz have disclosed no relevant financial relationships.

American Academy of Ophthalmology (AAO) 2014 Annual Meeting: Abstract PO473. Presented October 20, 2013.

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