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 Researchers found that just 65 percent of youth with type 1 diabetes
and 42 percent of those with type 2 diabetes had vision-loss
screening within six years of their diabetes diagnosis.
“More youth now than ever are being diagnosed with diabetes. By
2050, the prevalence with type 1 will triple and the prevalence with
type 2 will quadruple, with the greatest increase in minority
populations,” said lead study author Dr. Sophia Wang of the
University of Michigan Medical School in Ann Arbor.
The American Academy of Ophthalmology recommends screening for
diabetic retinopathy five years after an initial diabetes diagnosis
for youth with type 1 diabetes while the American Diabetes
Association and the American Academy of Pediatrics recommend
screening within three to five years. For kids with type 2 diabetes,
screening is recommended at diagnosis.
Diabetic retinopathy is a complication of diabetes that may not have
symptoms in early stages but can progress to vision loss. The damage
to the retina of the eye results from damage to tiny blood vessels
that affects other parts of the body as well.
About half of people with retinopathy develop diabetic macular
edema, a fluid build-up in the retina, or glaucoma.
“Diabetic retinopathy is the number one cause of vision loss in ages
20-74, so screening is an important component of diabetes care,”
Wang told Reuters Health by email.
To see how many kids with diabetes are getting the recommended
screening, Wang and colleagues analyzed data from a national managed
care network, which included more than 5,400 youth under age 21 with
type 1 diabetes and 7,200 with type 2 diabetes.
Overall, researchers found that about 4,000 kids, or 31 percent, had
an eye exam.
Those with type 1 diabetes were more likely to have had an eye exam
compared with those who had type 2 diabetes, the study team reports
in JAMA Ophthalmology . White and Asian youth were more likely to
have had exams than black and Latino youth. Those with a higher
household net worth were also more likely to receive an eye exam
compared with those in lower-income households.
“Despite the fact that all the youth in our study possessed health
insurance, we found disparities by race and family affluence,
suggesting that they may be particularly at risk,” Wang said.
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In the study, 11 percent of black children and teens and 18 percent
of Latino youth were less likely to undergo an eye exam compared to
white kids. Younger patients were also less likely to receive an
exam than older ones.
“We must educate adolescents and caregivers on the importance of
screening to improve care coordination between different medical
specialists such as pediatricians, endocrinologists,
ophthalmologists and optometrists,” said study author Dr. Joshua
Stein of the University of Michigan Kellogg Eye Center in Ann Arbor.
“More research is needed on new technologies which might render
ophthalmic screening more accessible, such as retinal photography
performed in primary care physicians’ clinics,” he told Reuters
Health by email.
Diabetic retinopathy is considered the most common microvascular
complication of diabetes and is projected to grow at an alarming
rate, said Dr. Seema Garg of the University of North Carolina at
Chapel Hill, who wrote a commentary accompanying the study.
“Visual impairment is detrimental to patients’ personal
independence, economic productivity, employment and overall quality
of life,” she told Reuters Health by email. “The opportunity costs
of a lifetime of blindness are enormous.”
Socioeconomics, geographical barriers, delayed referrals from
primary care doctors, language barriers and cultural barriers also
play a part in the screening gap. Retina screening via telemedicine
could help address the issue, especially for racial minorities and
economically disadvantaged youth, Garg writes in the commentary.
“Telemedicine is an emerging strategy for improving screening with
remote expert interpretation,” she writes. “Telemedicine is
effective in reaching underserved populations in remote, rural or
urban settings where patients may be at risk for more advanced
disease.”
SOURCE: http://bit.ly/2nAJHv1 and http://bit.ly/2nQkjn2 JAMA
Ophthalmology, online March 23, 2017.
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