According to the Centers for Disease Control and Prevention, more than a quarter of a million children, teens and young adults in the U.S. live with type 1 diabetes. Another 48,000 are diagnosed with type 2 diabetes. These young patients require ongoing specialized care and monitoring for complications of diabetes. In addition, they and their families need to build skills and develop healthy habits to manage diabetes outside the clinic and into adulthood, including creating a routine of regular eye health screenings.
As an American Diabetes Association (ADA) certified program, pediatric endocrinology at Arkansas Children’s Hospital has a unique opportunity and responsibility to provide a foundation for successful lifelong diabetes management.
"Our program is supported by a multidisciplinary approach with physicians, APRNs, certified diabetes educators, dieticians and social workers," said Jurhee Freese, M.D., pediatric endocrinologist at Arkansas Children's Hospital. "We have now added the ability to screen for diabetic retinopathy during clinic visits through the use of Topcon digital equipment for ophthalmology."
In pediatric patients with type 1 diabetes, the ADA recommends dilated fundoscopy or retinal photography every two years to screen for diabetic retinopathy beginning at three to five years of diabetes duration, puberty or 11 years old, whichever comes first. For those with type 2 diabetes, annual retinopathy screenings are recommended beginning at diagnosis. Ongoing hypertension screenings are also recommended during every clinic visit, starting at diagnosis of either type 1 or type 2 diabetes.
The Topcon combines an automated high-resolution retinal camera with artificial intelligence software to screen for diabetic retinopathy and hypertension without dilation. The technology allows patients to receive regular examinations and screenings based on concerning symptoms within the diabetes clinic at Arkansas Children's Hospital, eliminating the need for an additional screening appointment and providing the physician with real-time data for clinical decision-making.
"Retinopathy most commonly occurs after the onset of puberty and five to 10 years of diabetes duration," Dr. Freese said. "Topcon enables Arkansas Children's Hospital to be proactive in detecting retinopathy in children with diabetes."
While thorough eye exams with an ophthalmologist are still recommended for pediatric patients with diabetes, the Topcon offers a simple, non-invasive solution to detect issues early. Routine use of the Topcon also highlights the importance of ongoing eye care for patients while establishing essential lifelong diabetic care routines.
Through accessible diabetes education, comprehensive care, innovative technology and leading-edge research, the endocrinology team at Arkansas Children’s Hospital aims to create a Diabetes Center of Excellence to improve the care provided to children with diabetes across the state.
"Any patient who can sit still and keep their eyes open so we can take the pictures is a good candidate for screenings using the Topcon," Dr. Freese said. "This innovative screening option contributes to improving care for our patients, which will help decrease their risk for retinopathy and other long-term complications from diabetes."
Whether it's a challenge to take time off work or find care for other children, insurance issues or a lack of transportation, barriers may prevent pediatric patients with diabetes from receiving the care they need. The team in the Arkansas Children's Hospital diabetes clinic is working to address those barriers and improve access to care.
Instead of scheduling an appointment and paying an ophthalmologist or optometrist for a simple screening, patients can receive this examination during their regularly scheduled diabetes clinic appointments. This access lowers the burden on patients and families, decreases clinicians' wait for screening results, and improves care and outcomes.
"By making retinopathy screening available during diabetes clinic appointments, we can help our young patients and their families obtain regular eye exams," Dr. Freese said. "It's one step in the process of eliminating barriers of care for patients."