Ocular Complications in Children with Diabetes Mellitus.
OBJECTIVE
The effectiveness of annual eye examinations in diabetic children is unclear. We sought to determine the prevalence and onset of ocular pathology in children with diabetes mellitus (DM), identify risk factors for ocular disease, and recommend a screening regimen for asymptomatic children.


METHODS
Retrospective, consecutive cohort study.


METHODS
Children aged less than 18 years with type 1 or 2 DM examined over a 4-year period.


METHODS
All children underwent a complete eye examination, including dilated fundoscopy and cycloplegic refraction. A literature review was performed, identifying the youngest reported age and shortest reported duration of DM before the diagnosis of diabetic retinopathy (DR).


METHODS
Prevalence of DR, cataract, high refractive error, and strabismus.


RESULTS
A total of 370 children (mean age, 11.2 years; range, 1-17.5 years) had 693 examinations, with a mean DM duration of 5.2 years (range, 0.1-16.2 years) and a mean hemoglobin A1c (HbA1c) of 8.6 (range, 5-≥14). No children had DR. A total of 12 children had cataract; 5 required extraction but were identified by decreased vision, not diabetic screening. A total of 19 children had strabismus; only 1 was microvascular paralytic strabismus. A total of 41 children had high refractive error. There were no associations between these conditions and duration or control of DM. In the literature, the youngest age at diagnosis of severe DR was 15 years, and the shortest duration of disease was 5 years.


CONCLUSIONS
Diabetic retinopathy is rare in children regardless of duration and control of DM. On the basis of our study and literature review, screening examinations for type 1 diabetes could begin at age 15 years or at 5 years after the diagnosis of DM, whichever occurs later, unless the child is judged by the endocrinologist as being at unusually high risk. Other ocular complications are identifiable through existing amblyopia screening methods.
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Megan M
MM
Geloneck
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Brian J
BJ
Forbes
Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
James
J
Shaffer
Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Gui-shuang
GS
Ying
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: binenbaum@email.chop.edu.
Gil
G
Binenbaum
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D012029:Refraction, Ocular / Q000502:physiology; D012030:Refractive Errors / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013285:Strabismus / Q000175:diagnosis / Q000209:etiology*; D015351:Vision Screening; D014792:Visual Acuity / Q000502:physiology
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human