Use of High Resolution Digital Retinal Imaging in the Early Detection of Retinopathy in Type 1 Diabetes

Abstract

Background: Type 1 Diabetes Mellitus is one of the most common endocrine and metabolic
conditions worldwide, affecting nearly half a million children under the age of 15 years with an
anticipated rise in incidence of 4%. The ocular complications of type 1 diabetes can be blinding
and thus, inflicting catastrophic consequences on quality of life. In this disease, the greatest
impact in the prevention of vision loss comes from early detection and treatment.
Methods: Retinal screening was performed to capture both right and left eyes of children as
young as 5 years of age. A Canon CR-2 Plus AF (Tokyo, Japan) non-mydriatic retinal camera
with a CMOS chip, a resolution of 18 megapixel and an ISO setting of 400 (range available is
from 200 to 6400 ISO) in sensitivity was used for these images. Image management used was
image SPECTRUM V5 (Canon USA, Irvine, CA), a postcapture imaging software that automatically
separated a color image into three (3) monochromatic images; namely blue, green and
red, to help visualize the nerve fiber layer, the retinal layers as well as the choroid, respectively.
Results: In subjects with positive findings (mild diabetic retinopathy), retinal pathology was
noted on digital imaging and involved retinal hemorrhages and vascular changes consistent with
microaneurysms. Severe nonproliferative diabetic retinopathy was detected in one 20-year-old
subject. One subject presented with cataract. Subjects with a positive finding were counseled
and a referral to an ophthalmologist was recommended.
Conclusions: Non-mydriatic retinal imaging used in mass screenings can help identify the early
retinal changes and advance the management and care of patients with diabetic retinopathy.
Improvements in digital imaging software and the ability to perform telemedicine from remote
locations, can aid eye health care providers in the detection and isolation associated with various
levels of retinopathy.