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

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

The current standard of care for pediatric DR screening is referral to an ECP for a dilated eye exam. Recently, the FDA approved the first autonomous artificial intelligence (AI) software that interprets 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 our institution, we were the first to implement this technology in pediatrics, demonstrating safety, effectiveness and equity, and cost-savings to the patient. We also found that minority youth, those with lower household income and Medicaid insurance were less likely to undergo recommended screening, yet were more likely to have DR. This is likely to worsen due to the disparate effects of COVID-19.