Cataract as Early Ocular Complication in Children and Adolescents with Type 1 Diabetes Mellitus

Abstract

Cataract is a rare manifestation of ocular complication at an early phase of T1DM in the pediatric population. The pathophysiological mechanism of early diabetic cataract has not been fully understood; however, there are many theories about the possible etiology including osmotic damage, polyol pathway, and oxidative stress. The prevalence of early diabetic cataract in the population varies between 0.7 and 3.4% of children and adolescents with T1DM. The occurrence of diabetic cataract in most pediatric patients is the first sign of T1DM or occurs within 6 months of diagnosis of T1DM. Today, there are many experimental therapies for the treatment of diabetic cataract, but cataract surgery continues to be a gold standard in the treatment of diabetic cataract. Since the cataract is the leading cause of visual impairment in patients with T1DM, diabetic cataract requires an initial screening as well as continuous surveillance as a measure of prevention and this should be included in the guidelines of pediatric diabetes societies.

ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents

“…Examination for cataracts should be performed otherwise at time of screening for diabetic retinopathy. Surgical removal may be required (49 of the reported 66 cases) …”

High Risk of Early Cataracts in Young Type 1 Diabetes Group: A Nationwide Cohort Study

“…Because retinopathy is considered to take at least 5 years to develop after the onset of hyperglycemia, the latest guideline of American Diabetes Association suggests eye examination 3–5 years after diabetic onset [ 2 , 28 ]. However, nearly all articles addressing diabetic cataracts deemed that it might tend to occur early in the course of T1D [ 14 – 18 , 30 – 32 ]. In our study, the hazard ratio of diabetic cataracts was tremendously high in the young group and then declined gradually as senile cataracts developed in the general population.…”

“…Transient cataracts during the course of diabetic ketoacidosis have been reported in children [ 39 , 40 ]. We suggest lens examination at the beginning of T1D, and that was also warranted by some experts and the International Society for Pediatric and Adolescent Diabetes [ 3 , 18 , 30 ].…”

“…Nonetheless, owing to the lower rate of steroid use in the T1D group of the first part and in the cataracts group of the second part, causes to be clarified, we deemed that it played a minimal role in diabetic cataracts. In addition, poor glycemic control was implicated in diabetic cataracts in many studies [ 17 , 18 , 30 , 51 ]. Hemoglobin A1c level was not registered in the NHIRD; thus, we tried to probe glycemic control by other vascular complications.…”

“…However, it is not uncommon for clinicians to diagnose cataracts in young T1D patients, among some even preceding their T1D presentations [ 14 – 17 ]. The prevalence varies greatly between 0.7% and 29% [ 18 , 19 ]. According to the Wisconsin Epidemiologic Study of Diabetic Retinopathy, the 10‐year cumulative incidence of cataract surgery was 8% in young diabetic patients [ 20 ].…”