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Ocular Examination for Children with Type 1 Diabetes

Children with diabetes may experience ocular complications; however, the usefulness of annual eye exams in this population is not clear. Therefore, researchers wanted to identify the incidence of ocular pathology, determine risk factors for ocular disease, and suggest appropriate screening routine for asymptomatic children with diabetes mellitus.

A retrospective, consecutive cohort study was performed, where children with either type 1 or type 2 diabetes were included. Children were aged less than 18 years old, and were studied over a 4-year period. A full eye exam was performed on every study subject, which included dilated fundoscopy and cycloplegic refraction. Thereafter, a literature review was conducted, determining the youngest age and shortest duration of diabetes before the diagnosis of diabetic retinopathy was identified. End points were prevalence of diabetic retinopathy, cataract, high refractive error, and strabismus.

A total of 370 children, with a mean age of 11 years, underwent 693 examinations. A mean duration of diabetes for five years and a mean HbA1C of 8.6% were identified. A total of 12 children were found to have cataract, where five children required extraction but were identified by visual deficiency, not diabetic screening. A total of 19 children had strabismus, where only one was microvascular paralytic strabismus. A total of 14 children had high refractive error. Researchers note that there were no associations between these conditions and duration or control of diabetes.

Researchers analyzed findings and claim that the incidence of diabetic retinopathy is rare in children. This was found to be the case even in the groups who had poor glucose control or were diagnosed at a very young age. In the literature, the youngest age at diagnosis of severe diabetic retinopathy was 15 years, and the shortest duration of disease was 5 years. Therefore, researcher Gil Binenbaum, MD, MSCE, suggests that eye exams could be initiated at a later age.

The authors conclude, based on literature review and current findings from the study, that eye examinations may begin at age 15 years or at 5 years after diagnosis of diabetes, whichever occurs later. Nonetheless, it is highly recommended that an initial screen be performed for individuals who are at higher risk for diabetic retinopathy, which include pregnancy or type 2 diabetes. However, future studies to identify a younger age requiring treatment for diabetic retinopathy may be useful for evidence based literature and guideline improvement.

Practice Pearls:

  • Current American Academy of Ophthalmology guidelines recommend diabetic retinopathy screenings begin five 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.
  • Researchers of this study conclude that eye exams may begin at age 15 years or at five years after diagnosis of diabetes, whichever occurs later.
  • Children identified as high risk for diabetic retinopathy, such as those who are pregnant or have type 2 diabetes, should be examined upon diagnosis.

Geloneck, Megan M., et al. “Ocular complications in children with diabetes mellitus.” Ophthalmology (2015).