Retinopathy Screening Not Needed in Some Diabetic Children

Current recommendations for diabetic retinopathy screening are not cost-effective for children with type 1 diabetes who successfully maintain strict glycemic control with intensive insulin therapy, report researchers. As Dr. William V. Tamborlane noted in comments to Diabetes in Control, "Diabetic retinopathy screening recommendations date back to when you had worse glycemic control and more rapid onset of retinopathy."

It would be more cost-effective to limit regular retinopathy screening to those children who exhibit persistent elevations in hemoglobin A1C levels, hypertension, or microalbuminuria — assessments that can be made during regular diabetes clinic visits, conclude Dr. Tamborlane and colleagues in the February issue of Diabetes Care.

The Yale group reviewed the results of retinopathy screening eye exams in 130 children with type 1 diabetes who met American Diabetes Association (ADA) screening criteria; i.e., they were older than 10 years of age and had diabetes for more than 3 years.

The researchers report that only three eye exams were positive for diabetic retinopathy. In one of the three, diabetic retinopathy was misdiagnosed; the other two cases were classified as possible transient microaneurysms in one eye each.
It is "striking," the authors say, that "none of the children had any verifiable or sustained evidence of early diabetic retinopathy."

Dr. Tamborlane concluded: "A lot of time, effort and money goes into screening diabetic children for early eye changes, and, as evidenced by our study, with very little yield, unless the children have other risk factors like high blood pressure, chronic elevations of A1C, and small blood vessel changes in the kidney."

Diabetes Care 2007;30:362-363.