title: Fundus Photography as a Screening Method for Diabetic Retinopathy in Children With Type 1 Diabetes: Outcome of the Initial Photography.
abstract: OBJECTIVE
  To determine the success rate of the initial fundus photography session in producing gradable images for screening diabetic retinopathy in children <18 years of age with type 1 diabetes (T1D), and to analyze outcome-associated factors.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Mydriatic red-free monochromatic 60-degree digital fundus images centered on the macula and optic disc of 213 patients were graded. Photography success was classified as "complete" if both images of both eyes were gradable, "partial" if both images of 1 eye were gradable, "macula-centered image(s) only" if only the macula-centered image of one or both eyes was gradable, and "unsuccessful" if neither macula-centered image was gradable.
  
  
  RESULTS
  Complete success was reached in 97 (46%; 95% confidence interval [CI], 39-52) patients, at least partial success in 153 (72%; 95% CI, 65-78) patients, success of macula-centered image(s) only in 47 (22%; 95% CI, 17-28) patients, and in 13 (6%; 95%CI, 3-10) patients fundus photography was unsuccessful. Macula-centered images were more often gradable in both eyes than optic disc-centered images (P < .001). Success of photography did not differ between right and left eye. Sex, age at diagnosis of T1D, and the duration of diabetes, age, and glycemic control at the time of initial photography were unassociated with complete success. Partial success tended to decrease with increasing age category (P = .093), and the frequency of gradable macula-centered image(s) only increased with increasing age (P = .043).
  
  
  CONCLUSIONS
  Less than half of the children achieved complete success, but in only 6% initial fundus photography was unsuccessful, indicating its value in assessing retinopathy in the pediatric setting.
authors.affiliation: Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: tcglog2@hotmail.com.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Gräsbeck
authors.affiliation: Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Sophia V
authors.initials: SV
authors.lastname: Gräsbeck
authors.affiliation: Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Päivi J
authors.initials: PJ
authors.lastname: Miettinen
authors.affiliation: Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Summanen
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis*; D003930:Diabetic Retinopathy / Q000097:blood / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D009887:Ophthalmoscopy / Q000379:methods; D010781:Photography; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human