Abstract
Background: The prevalence of diabetic retinopathy (DR) in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) is 5.6% and 9.1%, respectively. The ADA recommends yearly screening for DR. Only two-thirds of youth with diabetes receive their annual dilated eye exam. In order to save time off from school/work for our patients and their families, we implemented point of care (POC) diabetic retinopathy screening in our pediatric diabetes clinic. We studied the impact on workflow, imaging time, and operator experience. Methods: As part of a larger prospective longitudinal study, we measured the implementation of DR screening and its impact on workflow, imaging time, and analyzed the camera operator learning curve. Results: We screened 39 youth with diabetes, average age 11.46y (range 6-17y). 35 (89%) had T1D, 4 (11%) had T2D. Patients were imaged without pharmacological dilation after their multidisciplinary diabetes team visit, or during a break between providers. Imaging was performed by a technician with no prior background in ocular imaging. Average imaging time was 7min14sec (SD 2.55, range 3.5-16.66). Analysis of technician operator learning curve showed average imaging time of 7min45sec for first 20 cases, compared to 6min44sec for second 19 cases. Images of readible quality were obtained with 1 attempt in 75%, and with 2 or more attempts in 25% of patients. All patients were able to be imaged. Conclusions: The use of a non-mydriatic fundus camera for diabetic eye screening in pediatrics is feasible, even in young children. It takes very little time, and requires minimal operator training. The overall rates of DR are low in children, and POC DR screening improves adherence to ophthalmic screening guidelines, and saves time off from school/work for diabetes youth and their families. Disclosure R.M. Wolf: None. C.G. Thomas: None. T. Liu: None. R. Channa: None. Funding Johns Hopkins Children's Center
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