Ocular Complications in Children with Diabetes Mellitus

Abstract

Objective The effectiveness of annual diabetic eye exams in 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. Design Retrospective consecutive cohort study. Subjects Children less than age 18 years with type 1 or 2 DM examined over a 4 year period. Methods All children underwent a complete eye exam, including dilated fundoscopy and cycloplegic refraction. A literature review was performed, identifying the youngest reported age and shortest reported duration of DM prior to the diagnosis of diabetic retinopathy. Main outcome measures Prevalence of diabetic retinopathy, cataract, high refractive error, and strabismus. Results 370 children (mean age 11.2 years, range 1–17.5) had 693 examinations, with mean DM duration 5.2 years (range 0.1–16.2), mean HbA1c 8.6 (range 5 to ≥14). No children had diabetic retinopathy. 12 had cataract; 5 required extraction but were identified by decreased vision, not diabetic screening. 19 had strabismus; only one was microvascular paralytic strabismus. 41 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 diabetic retinopathy was 15 years and the shortest duration of disease was 5 years. Conclusion Diabetic retinopathy is rare in children regardless of duration and control of DM. Based upon our study and literature review, screening examinations for type 1 diabetics 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 unusally high risk. Other ocular complications are identifiable through existing amblyopia screening methods.

ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents

“…Recent reports have found low rates of referral for retinopathy screening in well-controlled diabetes pediatric clinics. 84,85 In the T1D Exchange Registry in the United States, less than 1% of 12 235 patients reported treatment for retinopathy 86 were found in those with lower family income and this group had higher rates of retinopathy, suggesting that the actual rate may be even higher. 87,88 Initial worsening of diabetic retinopathy can occur with the initiation of improvement in glycemic control as occurred in the DCCT but such worsening did not result in clinically significant visual loss and over time, intensive therapy continued to be superior to standard therapy.…”

Corneal Endothelial Morphology in Children with Type 1 Diabetes

“…Diabetic retinopathy is the most commonly investigated ocular complication [4]. However, morphologic and functional changes in the cornea have been studied less frequently in diabetic eyes.…”

High rates of ocular complications in a cohort of Haitian children and adolescents with diabetes

“…Nine out of ten (90%) of study participants suffering from cataracts underwent or were awaiting surgery, a higher proportion compared to the 41% reported in the literature, 1 and at least 2 participants suffered from blindness due to complete lens opacification in 1 or both eyes.…”

“…4 Depending on the technique used, participants' age, duration of diabetes at evaluation, type of diabetes and ethnicity, higher rates of up to 28% have been reported. 5 Cataracts in children with diabetes are a rare occurrence, with prevalence estimated at 3.3%, 1 and require surgery in 41% if present. 1 A few reports have raised concern that children of non-Caucasian ancestry may develop ophthalmic complications precociously.…”

“…5 Cataracts in children with diabetes are a rare occurrence, with prevalence estimated at 3.3%, 1 and require surgery in 41% if present. 1 A few reports have raised concern that children of non-Caucasian ancestry may develop ophthalmic complications precociously. [6][7][8][9][10][11] However, only sparse data on the topic is available in children of Abbreviations: BMI, body mass index; CDC, Centre for Disease Control; DR, diabetic retinopathy; DM, diabetes mellitus; kg, kilogram; m, meter; SD, standard deviation; IU, international units African ancestry living in low-resource setting, 12,13 and no study exists in children of Haitian descent.…”