Advances in Type 1 Diabetes Ocular Remote Tele-Health Screening

Abstract

Background: Type 1 diabetes affects approximately 3 million Americans. Subjects are on average 14-years-old at time of diagnosis. It is a systemic, chronic condition that has retinal complications. Yearly ophthalmic consultation is important to maintaining adequate ocular health. The National Institute of Health (NIH) estimates that about half of individuals affected by diabetes are not aware they have some level of retinopathy.1 The goal of community base remote screenings is to identify at risk individuals and refer them for comprehensive clinical evaluation and possible intervention. Methods: Retinal screenings were conducted in July 2016 in conjunction with annual Friends for Life convention organized by Children with Diabetes (http://www.childrenwithdiabetes. com). In total, 218 participants were included in a comprehensive retinal screening. Self-reported baseline measurements of body mass index (BMI), blood pressure (BP), visual acuity and pupil size were recorded. An auto-refractor (Canon, Tokyo, Japan) and automated puff tonometer (Canon, Tokyo, Japan) were used to note visual acuity and intraocular pressure (IOP). Imaging modalities used to assess ocular health included a spectral domain ocular coherence tomography (OCT) (Optovue, iVue, Fremont, California, USA), ocular coherence tomographyangiography (Optovue, iVue, Fremont, California, USA), and a non-mydriatic retinal camera (Canon, Tokyo, Japan). Results: Our ocular screening included 218 participants, 61%female and 39% male. Ages ranged from 4 to 73 with an average of 19±12.8 years. The average blood pressure was 111/70. HbA1C ranged from 5.1 to 13.0 with an average of 7.6±1.16. Average duration of diabetes for all subjects was 10 years. Most subjects on average had been using insulin pumps and continuous glucose monitoring devices (CGM) for 7 and 3.5 years respectively. Of the 218 subjects ten had dot hemorrhages, three had flame hemorrhages and one had intraretinal microvascular abnormalities (IRMAs) affecting at least one eye. One subject required emergency referral to medical retina while 15 were referred for anterior segment evaluation for nuclear sclerosis. Conclusions: Comprehensive remote screenings including OCT, OCT-A and non-mydriatic retinal evaluation can provide a quick, efficient way to assess ocular health in T1DM. Yearly ophthalmic consultation can help detect retinal health at an early stage and better implement lifestyle modifications to minimize further complications.