Diagnosis of retinopathy in children younger than 12 years of age: implications for the diabetic eye screening guidelines in the UK

Hamid, Aisha; Wharton, Helen; Mills, Andrew C.; Gibson, Jonathan; Clarke, Margaret; Dodson, P M

doi:10.1038/eye.2016.59

“…DR, although a common complication in type 1 and type 2 diabetes, is rarely observed in children and young adults, and this has been attributed to the fact that several years are required from the onset of diabetes to the development of clinically significant retinal changes [202]. A retrospective analysis of 143 patients aged 12 years or younger, who attended diabetic eye screening for the first time in a Birmingham DR screening programme, identified only 12 patients (8.4%) with DR (mild DR without diabetic maculopathy); no patient was identified with sight-threatening DR at the initial assessment [202].…”

Section: Section 7: Diabetic Retinopathy In Children and Young Adultsmentioning

confidence: 99%

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Amoaku

¹

,

Ghanchi

²

,

Bailey

³

et al. 2020

Eye

View full text Add to dashboard Cite

The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.

show abstract

“…Probably, this results from better metabolic control effect, more physiological treatment using CSII by means of an insulin pump, more frequent use of continuous glucose monitoring, and more active and aggressive treatment based on monitoring trends. However, the analysis from the United Kingdom demonstrated that 9.5% of children under 12 years old had signs of background DR [ 10 ]. Our study also included children with poor metabolic control, but none of them had any signs of DR (neither in fundoscopy nor on fundus color photography), even after 14 years of T1D duration.…”

Section: Discussionmentioning

confidence: 99%

Influence of Metabolic Parameters and Treatment Method on OCT Angiography Results in Children with Type 1 Diabetes

Wysocka‐Mincewicz

¹

,

Baszyńska-Wilk

²

,

Gołębiewska

³

et al. 2020

Journal of Diabetes Research

View full text Add to dashboard Cite

Aim. To evaluate the influence of metabolic parameters and the treatment method in children with type 1 diabetes (T1D) on the optical coherence tomography angiography (OCTA) results as early markers of diabetic retinopathy (DR). Material and Methods. This prospective study enrolled 175 consecutive children with T1D. OCTA was performed using AngioVue (Avanti, Optovue). Whole superficial capillary vessel density (wsVD), fovea superficial vessel density (fsVD), parafovea superficial vessel density (psVD), whole deep vessel density (wdVD), fovea deep vessel density (fdVD), parafovea deep vessel density (pdVD), foveal thickness (FT), parafoveal thickness (PFT), and foveal avascular zone (FAZ) in superficial plexus were evaluated and analyzed in relation to individual characteristics, i.e., sex, weight, height, body mass index (BMI), and metabolic factors: current and mean value of glycated hemoglobin A1c (HbA1c). Furthermore, the analysis concerned the diabetes duration, age at the T1D onset, and type of treatment—multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII). Results. In the study group, we did not identify any patient with DR in fundus ophthalmoscopy. Age at the onset of diabetes correlated negatively with FAZ ( r = − 0.17 , p < 0.05 ). The higher level of HbA1c corresponded to a decrease of wsVD ( r = − 0.13 , p < 0.05 ). We found significantly lower fsVD ( 32.25 ± .1 vs. 33.98 ± .1 , p < 0.01 ), wdVD ( 57.87 ± .1 vs. 58.64 ± .9 , p < 0.01 ), and pdVD ( 60.60 ± .2 vs. 61.49 ± .1 , p < 0.01 ) and larger FAZ area ( 0.25 ± .1 vs. 0.23 ± .1 , p < 0.05 ) in the CSII vs. MDI group. Conclusion. The metabolic parameters, age of the onset of diabetes, and treatment method affected the OCTA results in children with T1D. Further studies and observation of these young patients are needed to determine if these findings are important for early detection of DR or predictive of future DR severity.

show abstract

“… 15 Furthermore, a recent large US study has shown an increase of 20% (95% CI 6%–35%) of the hazard of DR for every one-point rise of HbA1c in children with T1D, and what is very important is that DR in children seems to progress rapidly. 16 However, it may be still controversial if all of the above is related to longer duration of T1D or to the influence of puberty. To eliminate any doubts we have decided to carry out an additional analysis to compare children with the same duration of diabetes.…”

Section: Discussionmentioning

confidence: 99%

Influence of puberty on retinal microcirculation in children with type 1 diabetes without retinopathy using optical coherence tomography angiography

Wysocka‐Mincewicz

¹

,

Gołębiewska

²

,

Baszyńska-Wilk

³

et al. 2021

Diabetes and Vascular Disease Research

View full text Add to dashboard Cite

Background: This study aimed to assess the influence of pubertal status on the results of optical coherence tomography angiography (OCTA) in children with type 1 diabetes (T1D). Methods: We enrolled 167 consecutive children with T1D. Retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density data underwent analysis. We divided the study population into three subgroups depending on the pubertal status. Results: Analysis of the prepubertal and pubertal subgroups revealed statistically significant differences in foveal thickness (FT) (p < 0.05) and foveal SCP (p < 0.02). Analyzing subgroups of the prepubertal and postpubertal children, we observed statistically significant differences in FT (p < 0.03), whole SCP (p < 0.02), and foveal SCP (p < 0.02). Comparison of the pubertal and postpubertal subjects revealed differences in parafoveal DCP (p < 0.003). In the groups matched depending on diabetes duration, we observed differences between prepubertal, pubertal, and postpubertal children in FT, PFT, and parafoveal SCP and DCP. Conclusion: Our data suggest that in a cohort of pubertal children with a short duration of diabetes, alterations in retinal vessel density occur early and progress during puberty.

show abstract

Diagnosis of retinopathy in children younger than 12 years of age: implications for the diabetic eye screening guidelines in the UK

Abstract: Aim To assess whether the current starting

Cited by 11 publications

References 12 publications

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Influence of Metabolic Parameters and Treatment Method on OCT Angiography Results in Children with Type 1 Diabetes

Influence of puberty on retinal microcirculation in children with type 1 diabetes without retinopathy using optical coherence tomography angiography

Contact Info

Product

Resources

About