This is the current release of the guideline.

All clinical reports from the American Academy of Pediatrics expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Children with type 1 diabetes mellitus

Ophthalmic Screening for Diabetic Retinopathy

1. Initial examination 3 to 5 years after diagnosis if older than 9 years, with annual follow-ups thereafter
2. Patient and parent education regarding the benefits of optimal metabolic control

Risk for and prevalence of diabetic retinopathy in children with type 1 diabetes mellitus

Not stated

Not stated

Not applicable

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not stated

Guidelines for Ophthalmic Screening for Diabetic Retinopathy (DR)

Screening guidelines for diabetic retinopathy (DR) have been published previously by the American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Diabetes Association. The recommendations regarding pediatric patients with type 1 diabetes mellitus are similar. The American Academy of Ophthalmology recommends annual screening beginning 5 years after the onset of diabetes. The guidelines from the American Diabetes Association include annual screening beginning 3 to 5 years after diagnosis of diabetes once the patient is 10 years or older. The American Academy of Pediatrics recommends an initial examination 3 to 5 years after diagnosis if older than 9 years, with annual follow-ups thereafter.

The recommendations reflect the fact that the incidence of DR in young children is negligibly small, and therefore children younger than 9 years do not require screening for DR. The incidence of retinopathy in young adolescents is also very low, particularly for proliferative DR. Although the risk of DR typically does not increase significantly until 8 to 10 years after diagnosis, the recommendation for annual screening beginning 3 to 5 years after diagnosis (in children who are older than 9 years) is reasonable, given that DR has been reported occasionally within this time.

Because children with type 1 diabetes mellitus are at a greatly increased risk of visual loss over the course of their lives, special attention should be given to identifying other causes of visual loss in these patients. Screening for potentially treatable visual disorders such as amblyopia is recommended for all children and should be performed with particular care in children with type 1 diabetes mellitus. Patient and parent education regarding the benefits of optimal metabolic control is also beneficial early in the course of the disease.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Early identification and treatment of diabetic retinopathy (DR) can decrease the risk of vision loss in affected patients.

Not stated

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

American Academy of Pediatrics

Section on Ophthalmology

Section on Endocrinology

Primary Authors: Gregg T. Lueder, MD; Janet Silverstein, MD

Section on Ophthalmology, 2003-2004: Steven J. Lichtenstein, MD, Chairperson; Edward G. Buckley, MD; George S. Ellis, Jr, MD; Jane D. Kivlin, MD; *Gregg T. Lueder, MD; James B. Ruben, MD

Past Section Executive Committee Members: Gary T. Denslow, MD, MPH, Immediate Past Chairperson; Inger Hansen, MD

Liaisons: Kyle A. Arnoldi, CO, American Association of Certified Orthoptists; Thomas K. Koch, MD, National Conference and Exhibition Planning Group; Michael R. Redmond, MD, American Academy of Ophthalmology; Michael X. Repka, MD, American Association for Pediatric Ophthalmology and Strabismus

Staff: S. Niccole Alexander, MPP

Section on Endocrinology, 2003-2004: *Janet Silverstein, MD, Chairperson; Surendra Kumar Varma, MD, Chairperson-elect; Stuart J. Brink, MD; Kenneth C. Copeland, MD; Francine R. Kaufman, MD; Paul B. Kaplowitz, MD; Robert P. Schwartz, MD, Immediate Past Chairperson

Staff: Laura Laskosz, MPH

*Lead authors

Not stated

This is the current release of the guideline.

All clinical reports from the American Academy of Pediatrics expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Electronic copies: Available from the American Academy of Pediatrics (AAP) Policy Web site .

Print copies: Available from American Academy of Pediatrics, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

None available

None available

This NGC summary was completed by ECRI on July 27, 2005. The information was verified by the guideline developer on August 23, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.