Something surprising happened when Gil Binenbaum, MD, MSCE, and his colleagues in the Division of Ophthalmology at The Children’s Hospital of Philadelphia examined children with diabetes: They kept failing to find what they were looking for.
“We examined many kids for diabetic eye complications, and they didn’t have diabetic retinopathy,” said Dr. Binenbaum, an eye surgeon, who is also an assistant professor of ophthalmology at the Perelman School of Medicine at the University of Pennsylvania.
Diabetic retinopathy (DR) is one of many potential complications caused by diabetes’ effects on the body’s blood vessels. Although DR can damage retinal tissue and seriously impair vision, the severe form of the condition is quite rare in children, regardless of how long they have had diabetes or how well they control their blood glucose levels, Dr. Binenbaum noted.
Dr. Binenbaum and collaborators from CHOP and the Scheie Eye Institute of the University of Pennsylvania began to question whether early screening of most diabetic children for DR was truly warranted by the clinical evidence. The researchers did a retrospective study of 370 children of many ages with type 1 and type 2 diabetes, all of whom had undergone at least one complete eye examination at CHOP between 2009 and 2013. None of the children had DR.
They then closely reviewed the research literature to analyze the prevalence and onset of severe DR in children with type 1 diabetes. They concluded that screenings for most children could begin at age 15 or at five years after diabetes is diagnosed, whichever occurs later. This is a departure from the current recommendations of the American Academy of Pediatrics, which apply to children with both types of diabetes: Start exams after age 9 or three to five years after diagnosis, whichever occurs later.
Taking into consideration the rarity of DR in children, and more importantly severe DR that might require treatment, and the financial and logistical burden of such eye exams, Dr. Binenbaum and colleagues suggest that those screenings could safely be delayed for children with type 1 diabetes. They encouraged collaborative consensus groups to consider reevaluating their screening guidelines for pediatric DR.
“It may make some people uncomfortable waiting that long, but there really isn’t good evidence that you need to examine children for diabetic retinopathy before that age,” Dr. Binenbaum said.
He added that exceptions should be made for children with type 2 diabetes, or for those with type 1 diabetes judged by their endocrinologist as being at unusually high risk. For adults with diabetes, and for adolescents with the condition who have begun receiving eye screenings, regular annual eye exams remain extremely important, Dr. Binenbaum noted, because diabetes is a leading cause of blindness in adults.
“Diabetic eye examinations remain very important; we just think that they can start later in most children,” Dr. Binenbaum said.
The researchers published their findings online this month in Ophthalmology.