Pediatric Type 1 Diabetes and Retinopathy

Diabetic retinopathy (DR) causes more new cases of blindness among young adults than any
other disease. More than 90% of individuals with type 1 diabetes (T1D) will have some form of
DR by 20 years after their diagnosis. DR is associated with long-term hyperglycemia and blood
glucose variability, which induces vascular endothelial dysfunction and destruction in the
retina, eventual retinal ischemia, and in the end, widespread neovascularization of the
retina and optic disk. When these fragile vessels bleed, they can cause vitreous hemorrhage
and loss of vision. Eventually the friable vessels fibrose and can result in retinal
detachment or further retinal ischemia.

Major risk factors for the development of diabetic retinopathy are time since diagnosis, age
at diagnosis, and severity of hyperglycemia. Retinopathy most commonly occurs at least three
years after diagnosis and most cases are diagnosed more than five years after the onset of
T1D. Current guidelines from the American Diabetes Association (ADA) and American Academy of
Ophthalmology (AAO) recommend that patients with T1D undergo an initial comprehensive dilated
fundoscopic evaluation once the individual has had diabetes for 3-5 years and has either
reached puberty or 10 years of age, whichever is earlier. These patients should receive a
yearly exam thereafter, or every two years based upon the recommendation of an eye care
professional. However, the prevalence of retinopathy in children is unknown and adherence to
these guidelines, especially in youth, has proven difficult. Thus, it is important to make
these guidelines more evidence based, as retinopathy is often asymptomatic until vision loss
occurs. The first step in this process is the determination of the prevalence of retinopathy
in a general population of youth with diabetes. This should be followed by determining which
children are most at risk, so the guidelines can provide realistic and pertinent guidance to
practitioners.