Diabetic Retinopathy in Children

Uncommon in young children
Microvascular complications may become evident in adolescence
- 3-6% of Type I diabetes
- 9-10% in Type II diabetes
Non-proliferative and vision-threatening retinopathy is rare before age 12

American Diabetes Association
- Comprehensive eye examination after they have had diabetes for 3-5 years if ≥ 11 years of age or puberty has started whichever is earlier
- Repeat dilated and comprehensive exams every 2 years
- Repeat exams can be less frequent (up to every 4 years) if A1C <8%
American Academy of Ophthalmology
- For Type I Diabetes
  - First eye exam 5 years after onset of diabetes then annually thereafter
- For Type II Diabetes
  - First eye exam at the time of diagnosis then annually thereafter

Stage	Fundus Findings	Progress of Risk to Proliferative Retinopathy
Mild	Microaneurysms only	6% at 5 years
Moderatge	Microaneurysms + hemorrhages, hard exudates, cotton wool spots, venous beading, or IRMA	18% at 5 years
Severe	4-2-1 rule (any of the following);hemorrhages in all 4 quadrants, venous beading in ≥2 quadrants, or prominent IRMA in ≥1 quadrant	50% in 1 year
Very-Severe	Two or more of the Severe features above	100% at 4 years in one series

Early PDR
- new extraretinal vessels usually around the optic nerve (NVD) and retina (NVE)
High Risk PDR
- NVD > 1/3 disc diameter
- NVD or NVE of any size with vitreous or pre-retinal hemorrhage
Leads to tractional retinal detachment
Neovascularization of the iris/angle can lead to neovascular glaucoma
50% left untreated will have profound vision loss