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    This retrospective study shows that diabetic retinopathy is rare in children regardless of diabetes control or disease duration, suggesting that ophthalmic screening guidelines may need updating for asymptomatic children with diabetes.  

    Current AAO guidelines encourage annual screening examinations for all patients with type 1 diabetes beginning 5 years after diagnosis. However, there is limited knowledge about the onset and prevalence of ocular complications in children.

    To address these questions, investigators examined the prevalence and onset of ocular pathology in children younger than 18 with type 1 or 2 diabetes.

    Among the 370 subjects included, none had diabetic retinopathy. A total of 12 children had cataract and 41 children had high refractive error. While 19 had strabismus, only 1 had microvascular paralytic strabismus. They also found no associations between these conditions with disease duration or control.

    Additionally, the authors performed a literature review that showed the youngest reported age at diagnosis of severe diabetic retinopathy was 15 years, and the shortest disease duration was 5 years.

    On the basis of these findings, the authors suggest that annual screening examinations for type 1 diabetes could begin at age 15 or 5 years after a diabetes diagnosis, whichever occurs later, unless an endocrinologist believes the child has an unusually high risk. Due to the lack of data on type 2 diabetes patients, children with type 2 disease could be considered within the high-risk category and begin screening upon diagnosis, similar to adults with type 2 diabetes.