Although routine eye exams in children with type 1 diabetes are important, not every child may have access to an eye care provider. One practitioner doing what he can to help change this is Dr. Ben Szirth, director of applied vision research and ophthalmic telemedicine at Rutgers New Jersey Medical School, who volunteers his time to provide free eye screenings to hundreds of children with diabetes.
Turning Lives Around
For the past 10 years, Szirth and a team of ophthalmology and optometry students from Rutgers have provided free comprehensive eye exams to children with type 1 diabetes who attend the annual Friends for Life conference held every Fourth of July weekend in Orlando, Fla. The event is put on by Children with Diabetes — an Ohio-based nonprofit providing education and support to families living with type 1 diabetes.
According to Szirth, about 2,600 people attend the annual Friends for Life conference, including children and their family members. During the 2016 event, Szirth and his team of 16 screened 261 children with type 1 diabetes.
For each child, Szirth and his team check their visual acuity and intraocular pressure, and then also take images of their eyes using OCT angiography and color retinal images as well as autofluorescence.
All the machinery, as well as computers and software, used for testing is donated by Canon USA and Optovue, which also donates the shipping to Florida. "Often I even have high-level technicians helping us put everything together so we can do readings quickly," Szirth said.
The 2016 Friends for Life vision screening team, led by Dr. Ben Szirth (bottom row, second from right) poses for a photo.
Additionally, the team pays close attention to things such as the child's blood pressure, which Szirth said is very important to look at when dealing with children with diabetes. "In ophthalmology, we often forget to look at blood pressure, but blood pressure is related to retinal ‘flame’ hemorrhages," he explains.
Once a child's intake is completed, Szirth or another member of the team meets with the child's guardians to go through all the data. On average, the process for each child from start to finish takes about 20 minutes. "Because we have so many kids, we have to be able to work in an environment that has to be fast," Szirth explained. "We have it set up (as) a clinic, but nobody sits because if you sit you get comfortable, it takes 40 percent longer and you lose patients. So everything we do, we do standing and we do very rapidly."
However, if they find a child with vision problems, "...we make a secondary appointment for the family in the evening where they can come back and we can calmly discuss our findings and the options with them, and offer them solutions to the problems that we’re looking at," Szirth added.
For example, Szirth told the story of one 18-year-old adolescent living with diabetes for eight years who missed the conference screening one year, and the next year returned with high blood pressure (145/95) and over 500 hemorrhages within his two eyes. According to Szirth, type 1 diabetes is a lifelong struggle that cannot be ignored, and this 18-year-old decided diabetes got in the way of his life style. “We were lucky to have an OCT-A to look at the actual structure of the blood vessels and FAZ, as well as see if there was macular edema,” he recalled. “We caught him just in time and we put him back under very strict control of his glucose 480 with his HgA1C was >14.”
Szirth said he followed the young adolescent — who happened to live in New Jersey — for the next eight months, seeing him every three weeks performing follow-up vision screenings, endocrine visits as well as seeing his GP to get his Bp under control with medication. In just less than a year, he was able to take the child from 500 retinal hemorrhages (Dot, Flame and IRMA) to only two Dot hemorrhages. “We were able to turn this person's life around,” Szirth added. “Instead of going towards vision loss, if he follows through he can have normal vision for a long time to come.”
Student volunteers from the 2016 Friends for Life team perform a vision screening.
A Gratifying Experience
Deciding to become involved with the Friends for Life conference was an easy decision for Szirth as he always enjoyed working with children and has been a long-time volunteer, also working with organizations such as VOSH International.
"For the years I’ve done this I have grown more, I have learned more, and I have received more than any of the people we’ve helped," Szirth said. "It’s certainly gratifying to be able to do this."
In addition to educating the children and their families about what they find during the vision screenings, Szirth and his team also use this opportunity to educate them about other things that can impact their child's vision.
"Because individuals with type 1 diabetes will develop cataracts 10 years before anyone else, we educate them a lot on wearing sunglasses, wearing hats, protecting themselves against sunlight so that they can have better outcomes and avoid the early onset of cataracts," Szirth explained. "We also talk a lot about food intake and exercise."
And Szirth also has a goal of teaching the children at Friends for Life that it's not a bad thing to go to the doctor. "We make it fun so they can get something out of it," he said.
Szirth also has specific goals for the medical and optometry students he brings with him to the annual event. Being the students mainly train with adults, he said it gives them an opportunity to learn clinical skills with children. And he also wants to educate these future eye doctors — regardless of which profession they choose — on how they can work together. "I try to create bridges and allow them to learn about each other's specialties so later on when they graduate they'll be working together," he added. Every year, the students present their work at ARVO, the American Optometric Association, and the American Academy of Ophthalmology.
He also hopes the students learn a life-long love for volunteering. "Four of our medical students that had gone through the program at Friends for Life have now actually become ophthalmologists, as well as four optometrists that are now serving their communities and they continue doing this type of work," Szirth said. "We want to plant seeds that people will continue this important work."
Szirth reminded us of the words from Helen Keller that “Life is either a daring adventure or nothing at all.”
For more information on Children with Diabetes, visit ChildrenWithDiabetes.com.