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    Earlier detection of diabetic retinopathy possible in children


    The patients had a mean visual acuity of 6/5 in their best eyes. Eight patients had visual acuities of 6/12 or worse in at least one eye, with ambylopia, optic atrophy, longstanding poor visual acuity, and refractive problems recorded as causes.  

    Twelve patients (8.4%) screened positive for diabetic retinopathy. All were found to have mild non-proliferative diabetic retinopathy without maculopathy in at least one eye. The retinopathy did not seem to threaten the vision of any of these patients.

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    The researchers divided these patients into two groups: the 72 who were younger than 12 years and the 70 who were 12 years old. They found seven patients (9.6%) in the group younger than 12 years and five (7.1%) in the 12-year-old group who screened positive, but the difference was not statistically significant.

    On the other hand, they found a significant difference in diabetes duration between those who presented with diabetic retinopathy and those who didn’t. The mean duration of diabetes diagnosis in those with diabetic retinopathy was 7.3 years (range 6–11 years) compared with 4.8 years (range 1 month–11 years) in those without diabetic retinopathy.

    No patient who had a diabetes diagnosis duration of less than 6 years had diabetic retinopathy. This finding fit into the pattern established by previous research.

    The results also confirmed previous findings that patients younger than 12 years can develop diabetic retinopathy. And the finding that none of the patients’ sight was threatened by their diabetic retinopathy also agreed with previous studies.

    So at what age should patients be screened for diabetic retinopathy?

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    That depends on the mission of the screening programme, the Birmingham researchers wrote. “If it is to detect STDR [sight-threatening diabetic retinopathy], then our data support 12 years of age to be the right age as demonstrated in our population.”

    But screening programmes might have other goals, they write.

    “If it is important to identify first detection of development of diabetic retinopathy, for example, to review diabetes medical management, then ideally diabetic retinopathy screening should start 6 years after the onset of childhood diabetes.”

    Since the NHS screening programme set a goal of detecting sight-threatening disease, 12 years of age still makes sense as the threshold, they decided.

    But they acknowledged some limitations to their study. First, it was limited to a population living in the United Kingdom. Since the screeners did not accurately record ethnicity, it could not be used in this analysis.

    Also the patients younger than 12 were referred by paediatric diabetologists on the basis of the duration of diagnosis, whereas the 12-year-olds were referred because of their age, creating the risk of selection bias.

    However, they concluded that their research supports the current NHS guidelines.

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