Children with type 1 diabetes can safely delay vision screenings
Eye screenings for diabetic retinopathy in children with type 1 diabetes should begin at age 15 years or 5 years after diabetes diagnosis, whichever comes later, according to research in Ophthalmology.
In a retrospective cohort study of children with type 1 and type 2 diabetes receiving eye exams, researchers found that diabetic retinopathy in children was rare, even in those with poor glucose control or diagnosed at a very young age.
“Severe diabetic retinopathy requiring treatment is very rare in children with type 1 diabetes mellitus,” Gil Binenbaum, MD, MSCE, attending surgeon at The Children's Hospital of Philadelphia and assistant professor of ophthalmology at the University of Pennsylvania, told Endocrine Today. “It has not been reported to occur prior to 15 years of age. Based upon available evidence in the literature, eye examinations to screen for diabetic retinopathy could begin at a later age.”
Binenbaum and colleagues analyzed data from 370 children (mean age, 11.2 years; mean diabetes duration, 5.2 years; mean HbA1c, 8.6%) with type 1 or type 2 diabetes receiving 693 complete, dilated eye exams from 2009 to 2013. Within the cohort, 338 children had type 1 diabetes; 32 children had type 2 diabetes. None of the children had diabetic retinopathy; 12 children had cataract (five children required extraction; none diagnosed during routine eye screening); 19 had strabismus; 41 had high refractive error (55.8% mild hyperopia).
Researchers found no association between the children’s eye conditions and the duration of diabetes or diabetes control. In an additional literature review, researchers found the youngest age at diagnosis of severe diabetic retinopathy was 15 years, whereas the shortest diabetes duration at diagnosis was 5 years.
Current American Academy of Ophthalmology guidelines recommend diabetic retinopathy screenings begin 5 years after a diagnosis of diabetes, whereas the American Academy of Pediatrics recommends beginning annual eye exams 3 to 5 years after a diabetes diagnosis or after age 9 years, whichever occurs later.
“We concluded that, based upon the study and a thorough review of the literature, that eye examinations may begin at age 15 years or at 5 years after diagnosis of diabetes, whichever occurs later,” Binenbaum said. “However, children thought to be at particularly high risk for diabetic retinopathy, including those who are pregnant and those who have type 2 diabetes, should be examined upon diagnosis. Consensus groups of ophthalmologists and endocrinologists could convene to review the available evidence and consider revising current screening guidelines. Additional research to identify cases of treatment-requiring diabetic retinopathy occurring at an age or duration from diabetes diagnosis younger than suggested in the literature could further help guide such decisions. This could be done in the form of national surveys of pediatric ophthalmologists and retinal specialists.”– by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.