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June 29, 2005

Complications

Question from Springfield, Virginia, USA:

My daughter has had type 1 diabetes for just over four years and has had A1cs between 7.0 and 8.0 since diagnosis (most recent 7.7). In response to my questions about additional evaluations of her health, our endocrinologist recently recommended that she start having annual eye exams. My problem/question is that the ophthalmology department at the Children's Hospital in our area uses dilated eye exams only to evaluate kids. From my reading on this site and others, it appears that fundus photography and non-dilated exams is the "gold standard" of care when it comes to evaluating for diabetic retinopathy. However, I have yet to find a pediatric ophthalmologist in our area who uses these methods. I want the best care for my child and am willing to travel to get it, but I don't have a clear idea how important this is. My endocrinologist couldn't answer this question for me. So, how important is it for us to find a doctor who will use the photography rather than just dilated exams? Is there another method of evaluating for retinopathy that we should consider? Is there any danger or long-term effects of annual dilation for young children?

Answer:

The standard of eye care is for a patient with type 2 diabetes to have a dilated eye exam soon after diagnosis and patients with type 1 diabetes to have a dilated eye exam five years after diagnosis and yearly thereafter for both. If retinopathy is detected, more frequent dilated eye exams are indicated. Photography is being looked at as a way to “screen” for retinopathy at remote sights were an eye professional may not be available. If retinopathy is “found,” then the patient is referred for a dilated eye exam for closer study. Photography has been used to screen large under-served populations. A dilated eye exam is still the “gold standard” and photography can be used to document retinopathy found during the course of a dilated eye exam. Annual dilated eye exams have been performed on many patients for many years now without any adverse effects. There is no alternate better way at this time to study the retina then by direct visualization through dilated pupils.

My experience backs my recommendation to my patients that the best way to avoid blinding diabetic eye disease is to keep your A1c under 6.5 and to have an annual dilated eye exam. Diabetic eye disease is a silent blinding disease that people can have “smoldering and brewing” within their eyes for 10 to 15 years and yet be completely unaware with perfect 20/20 vision. To not have a dilated exam has more serious consequences then the inconvenience of the procedure.

CAG