Diabetic Retinopathy in Children with Type 1 Diabetes—Occurrence and Screening Using Optical Coherence Tomography

Abstract

Purpose: To describe the occurrence of diabetic retinopathy, the principles for pediatric care of patients with diabetes, and the utility of optical coherence tomography. Pediatric patients with type 1 diabetes should be screened for diabetic retinopathy upon the lapse of 5 years following the diagnosis. The patients in the time of puberty, who should be screened promptly after the diabetes diagnosis, and patients with type 2 diabetes are the exceptions. Special attention must be paid not only to retinopathy, but also to other possible concomitant conditions, such as cataract, refractive errors, or neuropathy. New techniques, such as optical coherence tomography angiography (OCTA), may contribute greatly to the early detection of retinopathy, facilitating the decision to modify the treatment. The application of modern insulin pumps with continuous glucose monitoring systems has greatly diminished the incidence rate of early symptoms of diabetic retinopathy in the pediatric population.

Review of Noninvasive Continuous Glucose Monitoring in Diabetics

“…Compared with NIR, OCT is unaffected by hematocrit and cardiac activity, thus can be used to noninvasively measure blood glucose concentration in human fingertips . OCT has been used to detect T1D currently . However, the method is highly sensitive to skin temperature and movement, and the complex detection methods and equipment limit its application in the home business …”

“…80 OCT has been used to detect T1D currently. 81 However, the method is highly sensitive to skin temperature and movement, and the complex detection methods and equipment limit its application in the home business. 39 Optical Polarimetry.…”

Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases

“…In pediatric patients with type 1 diabetes (T1D), diabetic retinopathy (DR) usually presents 8 to 10 years after diagnosis [ 93 ]. The prevalence of DR mostly ranges from 2% to 10% in the pediatric population and increases with age [ 94 ]. Most studies shed light on the early detection of subclinical retinal changes in T1D.…”

Changes in early optical coherence tomography angiography among children and adolescents with type 1 diabetes: Relation to fibroblast growth factor 21

“…Approximately one third of all people with diabetes have DR, out of which one third have vision threatening retinopathy that needs urgent treatment 7 . Although paediatrics are at low risk for DR, some adolescents can develop clinically significant macular oedema or even proliferative retinopathy 8 . The pubertal status and the pre‐pubertal diabetes duration may influence the risk of developing DR with some studies showing an association between peri‐pubertal diagnosis of T1DM and DR 9,10 …”

“…7 Although paediatrics are at low risk for DR, some adolescents can develop clinically significant macular oedema or even proliferative retinopathy. 8 The pubertal status and the pre-pubertal diabetes duration may influence the risk of developing DR with some studies showing an association between peri-pubertal diagnosis of T1DM and DR. 9,10 DR is commonly diagnosed and graded using fundus photography. It is subdivided into non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR), depending on the occurrence of neovascularisation.…”