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## Complete Summary

#### GUIDELINE TITLE

Screening for retinopathy in the pediatric patient with type 1 diabetes
mellitus.

#### BIBLIOGRAPHIC SOURCE(S)

Lueder GT, Silverstein J. Screening for retinopathy in the pediatric
patient with type 1 diabetes mellitus. Pediatrics 2005 Jul;116(1):270-3.
\[31 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15995070)

#### GUIDELINE STATUS

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.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Type 1 diabetes mellitus

-   Diabetic retinopathy (DR)

#### GUIDELINE CATEGORY

Risk Assessment\
Screening

#### CLINICAL SPECIALTY

Endocrinology\
Family Practice\
Ophthalmology\
Pediatrics

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

-   To provide recommendations on screening for retinopathy in the
    pediatric patient with type 1 diabetes mellitus

-   To review the risk factors for the development of diabetic
    retinopathy (DR) and screening guidance for pediatric patients with
    type 1 diabetes mellitus

#### TARGET POPULATION

Children with type 1 diabetes mellitus

#### INTERVENTIONS AND PRACTICES CONSIDERED

**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

#### MAJOR OUTCOMES CONSIDERED

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

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

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

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**[Guidelines for Ophthalmic Screening for Diabetic Retinopathy
(DR)]{.underline}**

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.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

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

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

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

#### POTENTIAL HARMS

Not stated

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Lueder GT, Silverstein J. Screening for retinopathy in the pediatric
patient with type 1 diabetes mellitus. Pediatrics 2005 Jul;116(1):270-3.
\[31 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15995070)

#### ADAPTATION

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

#### DATE RELEASED

2005 Jul

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Section on Ophthalmology

Section on Endocrinology

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*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*

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

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.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Policy Web
site](http://pediatrics.aappublications.org/cgi/content/full/116/1/270).

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

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

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

#### COPYRIGHT STATEMENT

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.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008