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Speaker: Eye screenings could start at older age in children with type 1 diabetes
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Screening examinations for diabetic retinopathy among children with type 1 diabetes could begin later than currently recommended, Megan M. Geloneck, MD, said in a presentation at the American Association for Pediatric Ophthalmology and Strabismus annual meeting.
Currently, the American Academy of Ophthalmology suggests that annual screening exams should begin 5 years after the onset of diabetes, while the American Academy of Pediatrics recommends annual screening exams every 3 to 5 years after the onset of diabetes or after age 9 years, whichever occurs later.
“However, in practice, we find that we’re commonly examining these children annually beginning at the time of their diabetes diagnosis,” Geloneck said. “The utility of these exams is rather uncertain.”
A retrospective consecutive cohort study looked at children younger than 18 years of age with type 1 or type 2 diabetes to determine the prevalence at onset of all ocular pathology, identify risk factors for ocular disease, and recommend a new potential screening regimen or validate existing regimens.
Primary outcomes were diabetic retinopathy, cataract, high refractive error and strabismus, while hemoglobin A1c (HbA1c), age at diagnosis and duration of diabetes were considered risk factors for ocular disease.
Over the 4-year period of review, a total of 370 children and 639 complete dilated eye examinations were identified.
Mean age was 11.2 years, with children ranging from 1 year to 17.5 years. Mean duration of diabetes was 5.2 years, ranging from a few months to more than 16 years. Mean HbA1c was 8.6%, ranging from very well controlled diabetes with HbA1c of 5% to very poorly controlled diabetes with HbA1c of greater than 14%.
No children had diabetic retinopathy. Eighteen eyes of 12 children had cataract, with nine eyes of five children requiring cataract extraction.
“Of particular note, all of these children who had significant cataracts requiring extraction presented symptomatically to our clinic with decreased vision and were not identified through routine diabetic screening exams,” Geloneck said.
The youngest age of cataract diagnosis was 7.5 years, occurring 4.5 years after diagnosis of diabetes. Nineteen children had strabismus, with one case attributed to transient sixth nerve palsy. High refractive error was seen in 41 children.
There were no associations between these risk factors and the duration or control of diabetes because all other complications were identified through existing amblyopia screening.
The youngest patient recorded as severe and nonproliferative was 18.8 years old, while the youngest patient reported with proliferative diabetic retinopathy was 15 years old.
The shortest duration of diabetes before onset of severe diabetic retinopathy was 5 years.
Recommendations
For children with type 1 diabetes, annual eye exams could begin at the age of 15 years or 5 years after diagnosis. For children with type 2 diabetes, annual eye exams should begin at the time of diagnosis, Geloneck said.
“Diabetic retinopathy in children is rare, and screening, we believe, can begin later than currently recommended,” she said. “Other complications such as cataract, strabismus or higher refractive error are presenting symptomatically or are identifiable through existing amblyopia screening programs.” – by Kristie L. Kahl
- For more information:
- Megan M. Geloneck, MD, can be reached at Scheie Eye Institute, 51 N. 39th St., Philadelphia, PA 19104; email: megangeloneck@gmail.com.
Disclosure: Geloneck reports no relevant financial disclosures.