COVID-19 had led to disruptions and delays in routine pediatric care. For children with diabetes who saw their diabetes team every 3 months, this had been reduced or transitioned to telemedicine due to COVID-19. However, those without technology and internet capabilities, namely low-income and minority youth, were less likely to participate in telemedicine and might have seen their diabetes team less frequently during the pandemic. Screening for diabetes complications, such as diabetic retinopathy (DR), was generally fulfilled by a separate visit to an eye-care professional (ECP), and was also less likely to occur during COVID-19.

Diabetic retinopathy affected 4-15% of youth with type 1 and type 2 diabetes and was a leading cause of blindness in adults as early as age 20. Yearly screening for DR was recommended, but only 35-72% of youth underwent screening, with minority youth and children from lower socioeconomic backgrounds less likely to undergo screening. Early detection of DR through screening prevented progression to vision loss.

The current standard of care for pediatric DR screening had been referral to an ECP for a dilated eye exam. Recently, the FDA had approved the first autonomous artificial intelligence (AI) software that interpreted retinal images taken with a non-mydriatic fundus camera, providing an immediate result for DR screening at the point of care (POC) for adults with diabetes.

In a pilot study at the institution, the team had been the first to implement this technology in pediatrics, demonstrating safety, effectiveness, equity, and cost-savings to the patient. The team had also found that minority youth, those with lower household income, and those with Medicaid insurance were less likely to undergo recommended screening but were more likely to have DR. This was likely to worsen due to the disparate effects of COVID-19.