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Diabetes Care 29:178-179, 2006
DOI: 10.2337/diacare.29.01.06.dc05-1908
© 2006 by the American Diabetes Association
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Letters: Comments and Responses

The Case for Biennial Retinopathy Screening in Children and Adolescents

Response to Stefánsson

Ann M. Maguire, MB, BAD, BCH1, Janine M. Cusumano1, Maria E. Craig, PHD1,2,3 and Kim C. Donaghue, PHD1,2

1 Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, Australia
2 Department of Paediatrics and Child Health, University of Sydney, Sydney, Australia
3 School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia

Address correspondence to Dr. 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

Stefánsson’s letter (1) and previous publication (2) strengthens our recommendation to extend the retinal screening interval for some children and adolescents who access specialist diabetes services to 2 years (3). However, individuals with other risk factors, poor glycemic control, or long diabetes duration should continue to be screened annually, and when significant retinopathy is detected screening should be annual or more frequent (depending on the severity of the retinopathy) (3). Our data relate to patients <20 years old and cannot be generalized to the adult population. Stefánsson states that in Iceland, no patient progressed from "no retinopathy" to "vision-threatening retinopathy" within 2 years. However, since collecting the original data (1990–2002), we have been informed of two former patients who had rapid progression from level 31 and level 45 retinopathy to blindness in <2 years. These patients were 21 and 23 years old when blindness occurred (therefore outside of our study group), and both had significant risk factors for retinopathy (persistently high HbA1c and diabetes duration 17 years).

Stefánsson describes a decrease in legal blindness due to retinopathy in the Icelandic population. Although this may be due to improved management of retinopathy, it may also indicate a reduction in retinopathy due to intensive insulin therapy. This would be in keeping with the trend in our population, in which the incidence of retinopathy has decreased over the last decade from 49 to 24% in patients of 8 years’ diabetes duration (4). However, despite the declining incidence of retinopathy in our population, adolescents should be advised of the serious and real risk of blindness due to diabetic retinopathy. Indeed, blindness occurred in the two patients mentioned above in 2003 and 2004. Clinicians must not underestimate the risk of future blindness from retinopathy for adolescents.

References

  1. Stefánsson E: The case for biennial retinopathy screening in children and adolescents (Letter). Diabetes Care 29:178, 2006[Free Full Text]
  2. Kristinsson JK, Gudmundsson JR, Stefánsson E, Jonasson F, Gislason I, Thorsson AV: Screening for diabetic retinopathy: initiation and frequency. Acta Ophthalmol Scand 73:525–528, 1995[Medline]
  3. Maguire AM, Chan AKF, Cusumano J, Hing S, Craig ME, Silink M, Howard NJ, Donaghue KC: The case for biennial retinopathy screening in children and adolescents. Diabetes Care 28:509–513, 2005[Abstract/Free Full Text]
  4. Mohsin F, Craig ME, Cusumano J, Chan AKF, Hing S, Lee JW, Silink M, Howard NJ, Donaghue KC: Discordant trends in microvascular complications in adolescents with type 1 diabetes from 1990 to 2002. Diabetes Care 28:1974–1980, 2005[Abstract/Free Full Text]

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A. M. Maguire, J. M. Cusumano, M. E. Craig, and K. C. Donaghue
The Case for Biennial Retinopathy Screening in Children and Adolescents: Response to Stefansson
Diabetes Care, January 1, 2006; 29(1): 178 - 179.
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