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The Case for Biennial Retinopathy Screening in Children and Adolescents

¹ Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW, Australia
² Ophthalmology Department, The Children’s Hospital at Westmead, Sydney, NSW, Australia
³ University of New South Wales, Sydney, New South Wales, Australia
⁴ University of Sydney, Sydney, New South Wales, Australia

Address correspondence and reprint requests to Ann Maguire, Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia. E-mail: annm4{at}chw.edu.au

OBJECTIVE—Current guidelines recommend annual retinopathy screening 2 years after onset (for pubertal-onset type 1 diabetes) and after 5 years (or age 11, whichever is earlier) for prepubertal onset. Our aim was to describe the natural history of retinopathy and to explore optimal retinal screening intervals for children and adolescents (aged <20 years) screened according to these guidelines.

RESEARCH DESIGN AND METHODS—More than 1,000 children and adolescents, followed longitudinally, were screened for retinopathy using seven-field stereoscopic fundus photography through dilated pupils. Of these, 668 had baseline and follow-up retinal screening. Using generalized estimating equations, we compared the risk of retinopathy with baselines at yearly intervals, in older and younger groups, in higher risk groups (diabetes duration >10 years or HbA_1c >10% at any screening), and after stratification 10 and <10 years in duration.

RESULTS—After 1 year, retinopathy did not increase significantly in the older group (n = 618, median HbA_1c 8.7%, range 8.0–9.5), younger group (n = 50, median HbA_1c 8.5%, range 8.0–9.2), or the higher-risk groups. Retinopathy increased significantly after 2 years in the older group (P = 0.003) but not until 6 years in the younger group (P = 0.01). In the group with HbA_1c >10% recorded at any visit, retinopathy increased significantly after 2 years (P = 0.001) but not until 3 years in the group whose HbA_1c was always 10% (P = 0.003). After the second eye assessment, retinopathy did not increase significantly until 3 and 6 years later in the older and younger groups, respectively (P = 0.028 and 0.014).

CONCLUSIONS—These results suggest that adolescents (in reasonable metabolic control) could safely be screened every 2 years rather than the currently recommended 1-year interval. In younger children, the next screening interval could be >2 years later. Individuals with especially poor control, duration >10 years, or significant retinopathy should be screened more frequently.

Abbreviations: DCCT, Diabetes Control and Complications Trial • GEE, generalized estimating equation • MSFP, mydriatic stereoscopic fundal photography

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