Why do eye checks matter with diabetes?
Diabetes can damage the tiny blood vessels of the retina, the light-sensing layer at the back of the eye. This is called diabetic eye disease. In the United States it is the leading cause of blindness in working-age adults. Found early, it can often be treated before it threatens sight.
It is less common in young people, but it does happen, and the risk rises with the number of years someone has had diabetes. American medical societies therefore advise regular eye checks from childhood or the teenage years. Yet, according to studies cited by the authors, only 35 to 72% of young people with diabetes have them. The barriers are well known: one more appointment, travel, and confusion about why the check matters.
What did the researchers do?
The ACCESS trial took place in pediatric diabetes clinics in the United States. It included 164 young people aged 8 to 21 with type 1 or type 2 diabetes who had not had an eye check for at least 6 months. They were randomly assigned to two groups. This is a randomized trial, the strongest way to compare two approaches.
In the first group, young people were referred to an ophthalmologist or optometrist, with clear explanations and a printed guide. In the second, a so-called autonomous AI did the exam on site: an operator took photos of the back of the eye, without drops to widen the pupil, and the AI gave its result in under a minute. Autonomous means it gives a result without a doctor reviewing the image.
What were the results?
In the AI group, all 81 young people had their eye exam: 100%. In the group referred to a specialist, 18 out of 82 had it within 6 months: 22%. The researchers saw no difference in this rate by ethnicity, income or parents' education.
In the AI group, 25 young people got a result showing eye disease. Of these, 16 out of 25, or 64%, went on to see a specialist within 6 months. In the other group, follow-up was 22%. Getting the result straight away, with explanations, seems to help people take the next step. Finally, 96% of the AI group said they were satisfied with the experience.
Key figures
- 100%of the AI group had their eye exam
- 22%of those referred to a specialist had it within 6 months
- 64%of young people with eye disease found by the AI then saw a specialist
Keeping track of your child's eye checks with Mima
This trial shows that an eye check done on site, during the diabetes visit, happens far more often. It is not offered everywhere yet, and in the United States this AI is not authorized for people under 22.
With Mima, you can note your child's appointments, tests and results, then prepare the question: "Can the eye check be done here, on the day of the clinic visit?" That way, nothing gets lost between visits.
What could this mean for patients?
Having the eye check during the diabetes visit saves an extra appointment and a journey. For families short on time or money, that is often what makes the difference. The authors note that Black, Hispanic and lower-income young people were less likely to have had the check before, and that on-site AI could help narrow these gaps.
For a parent, this can become a simple question for the diabetes team: can the eye check be done here, on the day of the clinic visit?
What are the limits of this study?
In the United States, this AI is authorized for adults, not for people under 22. That is why a retina specialist also reviewed every image. The group was small, with 164 young people, and some already knew this exam from an earlier study, which may have made them more willing to take part.
The trial measured whether the exam and follow-up happened, not yet whether young people's sight was better protected in the long run. Also, young people did not need drops to widen their pupils, which is not always true for adults.
Frequently asked questions
Why should a young person with diabetes have their eyes checked?
Diabetes can damage the retina without symptoms at first. Regular checks can find problems early, when they can still be treated.
Is the AI eye exam unpleasant?
In the study, it meant taking photos of the back of the eye, without drops, in 5 to 10 minutes. No adverse events were reported.
Is this AI authorized for children?
Not in the United States, where it is authorized for adults. In the trial, a retina specialist also checked every image.
What happens if the AI finds eye disease?
The young person is referred to an eye specialist for assessment and, if needed, treatment. In the trial, 64% of them attended within 6 months.
The original study
Wolf RM, Channa R, Liu TYA, et al. “Autonomous artificial intelligence increases screening and follow-up for diabetic retinopathy in youth: the ACCESS randomized control trial” Nature Communications, January 11, 2024. DOI : 10.1038/s41467-023-44676-z
Read the full study in Nature CommunicationsThis article summarizes a scientific study and is not medical advice.