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    Earlier detection of diabetic retinopathy possible in children

    Screening programmes could catch diabetic retinopathy earlier if they began screening 6 years after diabetes is diagnosed, researchers said.

    However, the study by researchers at Heartlands Hospital in Birmingham, UK, found that no sight-threatening diabetic retinopathy emerged in children younger than 12. They published their finding in the journal Eye.

    Current UK guidelines of the National Health Service (NHS) Diabetic Eye Screening Programme call for screening for diabetic retinopathy to begin at age 12.

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    That threshold was established in 2005 when the screening programme started because of a report finding that the youngest person to have sight-threatening diabetic retinopathy was nearly 12 years old.

    However, other studies have shown that a small percentage of patients develop diabetic retinopathy at a younger age. 

    As an audit of the programme, the Birmingham researchers retrospectively analysed diabetic retinopathy in 143 patients aged 12 years or younger registered with the Birmingham, Solihull, and Black Country Diabetic Eye Screening Programme.

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    55% of the patients were boys and 98% had diabetes mellitus type 1. The mean age at first diabetic eye screen was 10.7 years, and they ranged in age from 7 years and  4 months to 12 years 11 months. Some of these patients were younger than 12 years because they were referred for screening from local hospital paediatric diabetes departments based on their age of diagnosis and diabetes duration.

    The mean duration of diabetes at the first screen was 5 years.

    Accredited optometrists and screeners performed the screening in optometry practices and hospitals.

    They used Snellen notation to measure best corrected visual acuity. With a digital fundus camera, they took two 45° images (one macula-centred and one optic disc-centred) through dilated pupils in each eye.

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    They performed grading according to English national grading definitions and NHS Diabetic Eye Screening Programme guidelines.

    The researchers used the screening database to establish the patients’ date of birth and age of first diabetic eye screen, as well as visual acuity and screening result.

    They considered the presence of any diabetic retinopathy as a screen-positive result.

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