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Efficiency of current diabetic retinopathy screening recommendations in a pediatric population

Smyda, Garry (2016) Efficiency of current diabetic retinopathy screening recommendations in a pediatric population. Master's Thesis, University of Pittsburgh. (Unpublished)

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Diabetic retinopathy (DR) is a microvascular complication that typically occurs with greater frequency as disease duration increases. Both the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes make recommendations that patients be screened for retinopathy starting at age 10 and after a disease duration of greater than 2 years. Because it is important to catch DR early to prevent vision loss to the patient, sensitive screening techniques such as digital fundus photography are in important tool in this effort. The public health cost of DR complications can be effectively reduced by instituting smarter screening recommendations, not screening those who are at very low risk, and preventing vision loss by early identification and treatment of DR.
In this study, patients attending a large pediatric diabetes clinic that met the screening recommendations were offered DR screening using digital fundus photography. A total of 440 patients both met screening criteria and had retinopathy screening data. Of the 440, 203 were screened in-clinic by an opthalmologist, and 236 had already been screened by an outside practitioner. 5.4% of those screened in-clinic were positive for DR, while 0.42%of those screened elsewhere were found to be DR+. Those with retinopathy had significantly longer disease duration, were older at the time of screening, had higher HbA1c, and higher triglycerides. All of the cases had measures exceeding the screening guidelines, with a minimum age at screening of 13.4 years, and a minimum diabetes duration of 6.5 years.
It is unknown if the difference in prevalence between the two screening locations is due to a true difference in prevalence, or a systematic underreporting of DR in the outside-screened group, or a combination of these factors. The screening method of the 236 screened outside was not reported, and cases may have been missed in this cohort. Further study will need to be done to better quantify who would benefit most from screening, but building a risk model will require a much larger, comprehensive study. While it appears that the current screening guidelines may be revised without decreasing sensitivity, when screening is done it must be done using the most accurate methods in order to be most effective in catching DR in early stages when treatment is still effective.
This study emphasizes the public health benefit to screening for diabetic retinopathy as a routine element of diabetes management. In fact, the patients who took advantage of screening offered by the clinic showed over 10 times the prevalence of those who had already received screening by an outside practice, and most of these patients would have not otherwise completed screening, even though they were within the guidelines. The benefit to state-of-the-art digital fundus photography DR screening in this at-risk cohort is clear.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorArena,
Committee MemberLibman,
Committee MemberCostacou,
Date: 29 June 2016
Date Type: Publication
Defense Date: 27 April 2016
Approval Date: 29 June 2016
Submission Date: 30 March 2016
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 33
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Biostatistics
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: diabetic retinopathy screening pediatric
Date Deposited: 29 Jun 2016 18:45
Last Modified: 01 May 2021 05:15


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