Fundus photography as a screening method of diabetic retinopathy in children and adolescents with type 1 diabetes Outcome of the first fundus photography at the age of 9–17 years

Abstract

PurposeTo study the success of fundus photography in screening of diabetic retinopathy (DR) in children <18 years with type 1 diabetes (T1D) in producing gradable images.MethodsPhotographic success of black‐and‐white macula and optic disc‐centered fundus images of both eyes of each patient was graded by one observer (TG) using a slightly modified classification of ARIC. All images were taken with a digital 60° Canon CF‐60UD camera. Photography as a whole was graded as ‘complete success’ if the images of both eyes were at minimum of fairly good quality (i.e. gradable), and ‘partial success’ if the images of only one eye reached this level.ResultsOf the 213 patients photographed for the first time in 2009–2013 at the Department of Pediatrics, 121 (57%) were males. The median age of diagnosis was 8 (range, 1–16) years and at the first photography 11 (9–17) years. At the first photography, the median duration of T1D was 2.3 (range, 0.2–9.6) years and the median HbA1c was 8.5% (range, 6.3–13.8).At least partial success was reached in 153 (72%; 95%CI, 65–78) patients and complete success in 97 (46%; 95%CI, 39–52) patients. Complete success was equally common among those aged 9–10, 11–12, and 13–17 years (45%, 46% and 47%). The macula‐centered images of 177 (83%; 95%CI, 77–88) patients, and the optic‐disc centered images of 103 (48%; 95%CI, 41–55) patients were gradable in both eyes. Age at the first photography was not associated with success (p = 0.20).ConclusionsLess than half of the first fundus images achieved complete success, but over 70% achieved at least partial success when photography was performed at the age of 9–17 years. No significant associations were identified. Photography is a reliable method for screening of DR also in pediatric setting.