title: Feasibility of retinal screening in a pediatric population with type 1 diabetes mellitus.
abstract: OBJECTIVE
  To study the feasibility of using a nonmydriatic camera to screen children with type 1 diabetes mellitus (DM1) as young as 2 years for diabetic retinopathy.
  
  
  METHODS
  Prospective pilot imaging study involving children with DM1 aged 2 to 17 years. The screening consisted of: (1) intake form; (2) measurement of blood pressure, pulse, and oximetry; (3) assessment of visual acuity (SIMAV, Padova, Italy); and (4) nonmydriatic color imaging (Canon CX-1 45° 15.1 megapixel camera; Canon Corp., Tokyo, Japan). Images were assessed for signs of diabetic retinopathy and graded for quality on a scale of 1 to 5 by two clinicians. Kappa coefficient was calculated to determine inter-observer agreement.
  
  
  RESULTS
  One hundred four of 106 (98%) children underwent imaging (mean age: 11.1 years, 51% male, 88% white). One (1%) child had nonproliferative diabetic retinopathy and 2 (1.9%) had incidental findings. Only 62% of children had an eye examination within the past year, with children with DM1 for more than 5 years significantly more likely to have done so (P = .03). Children who had an eye examination within the past year were significantly older than their counterparts (P = .01). Images of high quality (grades 4 and 5) were acquired in 178 (86%) eyes, and images of some clinical value (grades ≥ 2) were obtained in 207 (99.5%) eyes. Inter-observer agreement for image quality was 0.896.
  
  
  CONCLUSIONS
  The feasibility of using a nonmydriatic camera to screen children as young as 2 years for changes related to diabetic eye disease was demonstrated. Nonmydriatic imaging may supplement standard dilated clinical ophthalmology examinations for select patient populations.
authors.forename: Anton M
authors.initials: AM
authors.lastname: Kolomeyer
authors.forename: Natasha V
authors.initials: NV
authors.lastname: Nayak
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Simon
authors.forename: Bernard C
authors.initials: BC
authors.lastname: Szirth
authors.forename: Khadija
authors.initials: K
authors.lastname: Shahid
authors.forename: Iris Y
authors.initials: IY
authors.lastname: Sheng
authors.forename: Tina
authors.initials: T
authors.lastname: Xia
authors.forename: Albert S
authors.initials: AS
authors.lastname: Khouri
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010092:Oximetry; D010781:Photography / Q000295:instrumentation*; D010865:Pilot Projects; D011446:Prospective Studies; D012171:Retinal Vessels / Q000473:pathology*; D015351:Vision Screening; D014792:Visual Acuity / Q000502:physiology