Some diabetic children may not need eye screening

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Researchers from Yale University School of Medicine, New Haven, Connecticut, have found that for diabetic children who are able to maintain strict control of their blood sugar (glucose) with intensive insulin therapy, screening for retinopathy is not yet necessary or cost effective.

Current guidelines for treating children with type 1 diabetes include eye exams to test for signs of retinopathy, damage in the blood vessels surrounding the retina, the light-sensitive tissue in the back of the eye that is necessary for vision.

A progressive condition, diabetic retinopathy is the most common eye disease and a leading cause of blindness in adults in the United States, according to the National Eye Institute at the U.S. National Institutes of Health.

As co-author Dr. William V. Tamborlane noted in comments to Reuters Health, “Diabetic retinopathy screening recommendations date back to when you had worse glycemic control and more rapid onset of retinopathy.”

It would be more cost-effective to limit regular retinopathy screening to those children who exhibit persistent elevations in glucose levels, High Blood Pressure or signs of kidney disease - evidence of diabetes progression. These assessments can be made during regular diabetes clinic visits, conclude Tamborlane and colleagues in the current issue of Diabetes Care.

The Yale group reviewed the results of retinopathy screening eye exams of 130 children with type 1 diabetes who met American Diabetes Association (ADA) screening criteria, which includes being older than 10 years of age and having diabetes for more than 3 years.

The researchers report that only three eye exams were positive for diabetic retinopathy. In one of the three, diabetic retinopathy was misdiagnosed; the other two children were diagnosed with possible transient microaneurysms—small local dilatations in the blood vessels surrounding the retina - in one eye of each child.

It is “striking,” the authors say, that “none of the children had any verifiable or sustained evidence of early diabetic retinopathy.”

Tamborlane concluded: “A lot of time, effort and money goes into screening diabetic children for early eye changes, and, as evidenced by our study, with very little yield, unless the children have other risk factors like High Blood Pressure, chronic elevations of (blood glucose) and small blood vessel changes in the kidney.”

SOURCE: Diabetes Care, February 2007.

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