IMPE Abstracts

Screening for diabetic retinopathy has been advocated since the finding that intervention with laser photocoagulation halved the risk of blindness in asymptomatic individuals with diabetes who have advanced retinopathy. More recently there has been a concern that screening with low yields of positivity is burdensome and expensive. Others have argued that the value of screening for diabetic retinopathy during adolescence includes an opportunity for education and motivation for improved glycaemic targets. However those at most risk may be also be less likely to use screening programs. With improved diabetes management the risk of retinopathy progression is undoubtedly reduced, and there may be a threshold of glycaemic control below which an adolescent may not be at risk, especially if no retinopathy at initial screen (Gubitosi-Klug RA, Pediatric Diabetes 2019). A recent review of registry data from 11 high income countries in Europe, North America and Australia, found the unadjusted prevalence of any DR was 5.8%, varying from 0.0% (0/276) to 16.2% between countries (Brasina N, Pediatric Diabetes, 2022). With screening of a community population over 30 years in Sydney, we found an incidence of moderately severe to severe retinopathy of 8.6 per 1000 patient years and macular oedema incidence of 4.6 per 1000 patient years followed from minimum of 10 years till maximum age of 25 years (Januszewski A et al, Diabetes Care 2022) which compares to an incidence of DME of 2.2 per 1000 patient years for the adolescent cohort of the DCCT followed to age 18 years. The most recent ISPAD Guidelines (Bjornstad P et al, Pediatric Diabetes 2022) recommend

• Screening for diabetic retinopathy should start at puberty or from age 11 years with 2–5 years diabetes duration (ADA Level B evidence).

• For those with diabetes duration less than 10 years, mild nonproliferative retinopathy and optimal glycemic targets, biennial screening assessment is recommended. The frequency of retinopathy screening can be reduced to 3 years if there is no retinopathy at first assessment but needs to be more frequent if there are high-risk features for visual loss (ADA Level E evidence).