Eye Screening Too Early?

One of the unfortunate realities of living diabetes is that even with good blood glucose control, many people will someday develop diabetic complications — especially if they’ve lived with diabetes for several decades. This means that children with diabetes — whether Type 1 or Type 2 — will need to undergo screening throughout their lives to ensure that any complications are detected early and can be treated effectively.

But when should screening begin? That’s the question — as it relates to diabetic retinopathy (eye disease) — that several researchers asked in a study published this month by the journal Ophthalmology. To answer this question, they recruited 370 children (about 11 years old, on average) with diabetes (any type) to undergo eye examinations over a four-year period. The children were screened for diabetic retinopathy as well as cataracts (cloudy lens of the eye), strabismus (abnormal eye alignment), and high refractive error (trouble focusing). The children had had diabetes for an average of about 5 years — up to as long as 16 years — and had an average HbA1c level (a measure of long-term blood glucose control) of 8.6%.

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As described in a HealthDay article on the study, the researchers found no signs of diabetic retinopathy in any of the children. While 12 of the children developed cataracts — 5 of which required surgery — these cases were discovered based on decreased vision, not the extra screening measures related to diabetes. Another 19 children had strabismus and 41 had high refractive error, but these conditions were not found to be associated with diabetes duration or with HbA1c.

Based on these results and a review of other scientific literature — in which the youngest reported age for severe diabetic retinopathy was 15, and the shortest diabetes duration leading to retinopathy was 5 years — the researchers concluded that screening for diabetic eye disease can wait until age 15 or 5 years after a diagnosis of Type 1 diabetes, whichever is later. (They recommended screening immediately following a diagnosis of Type 2 diabetes, since the disease often goes undetected and uncontrolled for years before diagnosis.) By contrast, some medical groups currently recommend beginning screening at age 9, or 3–5 years after a Type 1 diabetes diagnosis.

The recommendation to delay screening aims to reduce unnecessary trouble for parents and children, as well as reduce the burden of unnecessary visits on the health-care system. But it stands to reason that many parents and children may be reassured by screenings for diabetic eye disease, and that some parents may wonder why a newly diagnosed 12-year-old with Type 2 diabetes should get screened, yet a 12-year-old who has had Type 1 diabetes for a decade should wait another 3 years. A separate question, of course, is whether people with well-controlled diabetes might be able to wait even longer before getting their eyes screened.

What’s your take on the new study — is it a good thing to reduce unnecessary eye screenings, or is reassurance worth the cost of more frequent exams? Do the blanket recommendations for Type 1 and Type 2 diabetes seem logical or arbitrary to you? Should further studies look at the relationship between blood glucose control and the risk of diabetic retinopathy at younger ages, so that only people with a higher risk of eye disease get screened earlier in life? Leave a comment below!