Pediatric Diabetic Retinopathy: Risk Factors and Management
Pediatric Diabetic Retinopathy: Risk Factors and Management
Diabetic retinopathy (DR), a common complication of both type 1 and type 2 diabetes, is rarely expressed at a level greater than background retinopathy during childhood and adolescence. Epidemiological studies in paediatric diabetic patients together with data from the Diabetes Control and Complications Trial have demonstrated the importance of glycaemic control in delaying or preventing the development of DR; thus, the incidence of DR has declined somewhat over the past two decades. Both prepubertal and postpubertal years with diabetes contribute to the overall probability of DR development. In addition to duration of disease and degree of glycaemic control, other risk factors for DR development include elevated blood pressure, lipid profiles, serum levels of advanced glycation endproducts, evidence for early stage atherosclerosis, increased calibre of retinal blood vessels and several genetic factors, such as enzymes involved in glucose and lipid metabolism. Annual screening is recommended, with mydriatic stereoscopic fundus photography being the most sensitive detection method. Both pathophysiology and treatment in paediatric populations are essentially the same as described for adult populations, with treatment usually not required until adulthood is reached.
Diabetic retinopathy (DR) is a major cause of vision loss in Western countries and is distinguished among other causes of visual morbidity in that it is reported across all age groups ≥40 years. Owing to the time required for its expression after the onset of diabetes, clinical retinopathy is rarely seen in paediatric populations. However, there is considerable literature examining the development of DR during childhood and adolescent years and the measures that are available to ameliorate its progression. This review focuses on the epidemiology, pathophysiology and treatment of DR in paediatric populations.
Abstract and Introduction
Abstract
Diabetic retinopathy (DR), a common complication of both type 1 and type 2 diabetes, is rarely expressed at a level greater than background retinopathy during childhood and adolescence. Epidemiological studies in paediatric diabetic patients together with data from the Diabetes Control and Complications Trial have demonstrated the importance of glycaemic control in delaying or preventing the development of DR; thus, the incidence of DR has declined somewhat over the past two decades. Both prepubertal and postpubertal years with diabetes contribute to the overall probability of DR development. In addition to duration of disease and degree of glycaemic control, other risk factors for DR development include elevated blood pressure, lipid profiles, serum levels of advanced glycation endproducts, evidence for early stage atherosclerosis, increased calibre of retinal blood vessels and several genetic factors, such as enzymes involved in glucose and lipid metabolism. Annual screening is recommended, with mydriatic stereoscopic fundus photography being the most sensitive detection method. Both pathophysiology and treatment in paediatric populations are essentially the same as described for adult populations, with treatment usually not required until adulthood is reached.
Introduction
Diabetic retinopathy (DR) is a major cause of vision loss in Western countries and is distinguished among other causes of visual morbidity in that it is reported across all age groups ≥40 years. Owing to the time required for its expression after the onset of diabetes, clinical retinopathy is rarely seen in paediatric populations. However, there is considerable literature examining the development of DR during childhood and adolescent years and the measures that are available to ameliorate its progression. This review focuses on the epidemiology, pathophysiology and treatment of DR in paediatric populations.
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