The Case for Biennial Retinopathy Screening in Children and Adolescents
- Ann Maguire, MB, BAD, BCH1,
- Albert Chan, MAPP, STAT1,
- Janine Cusumano1,
- Stephen Hing, MBBS12,
- Maria Craig, PHD13,
- Martin Silink, MD14,
- Neville Howard, MBBS1 and
- Kim Donaghue, PHD14
- 1Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- 2Ophthalmology Department, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- 3University of New South Wales, Sydney, New South Wales, Australia
- 4University 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
Abstract
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 HbA1c >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 HbA1c 8.7%, range 8.0–9.5), younger group (n = 50, median HbA1c 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 HbA1c >10% recorded at any visit, retinopathy increased significantly after 2 years (P = 0.001) but not until 3 years in the group whose HbA1c 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.
- DCCT, Diabetes Control and Complications Trial
- GEE, generalized estimating equation
- MSFP, mydriatic stereoscopic fundal photography
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted November 9, 2004.
- Received June 9, 2004.
- DIABETES CARE
