Eyeworld

EW RETINA 68 by Vanessa Caceres EyeWorld Contributing Writer Children, teens not screened often enough for diabetic retinopathy Researchers track drawbacks of delayed screening in youths with type 1, 2 diabetes T he growth of type 2 diabe- tes in the U.S. is well-publi- cized. Diabetes now affects children and teens more frequently, as the obesity epidemic continues. In fact, type 2 diabetes now makes up almost 50% of all new diabetes diagnoses among teens, according to diabetes researchers. Ophthalmologists know all too well about the risk for vision loss associated with diabetes. One might hope that the increase in diabe- tes has led to more frequent eye examinations to check for diabetic retinopathy (DR). However, new research from Sylvia Wang, MD, Department of Ophthalmology and Visual Scienc- es, University of Michigan Medical School, Ann Arbor, and co-investi- gators found that such exams aren't happening often enough. 1,2 Their two recent studies were published earlier this year in Oph- thalmology and JAMA Ophthalmology. DR study details The study published in Ophthalmol- ogy focused on risk factors among youths with type 1 or 2 diabetes for the development of diabetic retinopathy. 1 In their retrospective longitudinal cohort research, Dr. Wang and co-investigators focused on youths age 21 or under who were newly diagnosed with type 1 or 2 diabetes and enrolled in a large U.S. managed care network. They identified 2,240 children and teens with type 1 diabetes and 1,768 with type 2 diabetes. A total of 14.4% of participants received a diagnosis of DR. Of these two groups, 20.1% and 7.2% developed DR during a median follow-up of 3.2 and 3.1 years, respectively. By 8 years of follow-up, 31.2% and 10.3%, respectively, had been diagnosed with DR. Those with type 1 diabetes developed DR faster; DR was more common in youths with a higher hemoglobin A1C score, a measure- ment used to track the average blood sugar over a 3-month period. A diagnosis of DR also was more common in males and as patients became older. Guidelines from medical asso- ciations recommend that screening for DR begin 3 to 5 years after the initial diagnosis of type 1 diabetes. The American Academy of Oph- thalmology (AAO) recommends an initial screening after type 1 diabetes is diagnosed, the American Diabetes Association (ADA) advises the first screening 3 to 5 years after onset in patients 10 years of age or older, and the American Academy of Pediatrics has the same recommendations as the ADA for patients age 9 or older. However, more than 18% of the children and teens in the study with type 1 diabetes had already developed DR before screening was recommended. Both the ADA and AAO advise that youths with type 2 diabetes be screened at their initial diabetes diagnosis; the study results sup- port this practice, the investigators reported. Early detection of DR is import- ant before vision loss occurs, the investigators concluded. "… pro- viders can increase the monitoring intensity, improve glycemic control, and coordinate care among eye-care providers, pediatricians, and endo- crinologists to avert or delay poor long-term visual outcomes and in- crease vigilance regarding nonocular complications of diabetes mellitus," they wrote. Researchers will need to develop more cost-effective strate- gies to screen for DR, including the possible use of telemedicine with non-mydriatic fundus photography in pediatricians' and primary care providers' offices, they wrote. DR screening patterns A second study from the investiga- tors focused on ophthalmic screen- ing patterns among youths with diabetes, based on those age 21 or younger who were in a large U.S. managed care network. This was also a retrospective cohort study, and it included 5,453 youths with type 1 diabetes and 7,233 youths with type 2 diabetes. By 6 years after their initial diag- nosis, 64.9% of type 1 patients and 42.4% of those with type 2 diabetes had eye examinations. Black and Latino children and teens were less likely to have an eye exam com- pared with white and Asian children and teens. Those from households with a lower net worth also were less likely to have eye exams. This occurred even though the patients in the study had health insurance. As a comparison, the inves- tigators cited studies tracking the prevalence of eye examinations in adults with diabetes and found rates spanning 20% to 82%. In a study called the National Long-Term Care Survey, a mean of 53% of Medicare beneficiaries who had diabetes re- ceived annual eye exams. 3 Factors associated with non-ad- herence to eye exams in adults have included a younger age, shorter diabetes duration, having type 2 di- abetes, and having the last eye exam performed by an optometrist or primary care physician (PCP) versus an ophthalmologist, the investiga- tors reported. "Our study confirmed some of these previously noted risk factors. In addition, we learned that race and economic status play an im- portant role in adherence to clinical The Canon CR-2 PLUS AF Digital Non-Mydriatic Retinal Camera provides color and fundus autofluorescence (FAF) imaging within a compact design. Diabetic retinopathy and other conditions that can affect vision may be identified and monitored using FAF mode. Source: Canon U.S.A. June 2017 Research highlight

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