Abstract
Purpose To compare clinical examination using green light with clinical examination using white light in detecting early diabetic retinopathy (DR) in juvenile diabetic patients with disease for 10 or more years.
Methods All patients were examined clinically using both green light and white light to determine the presence of DR. Each patient underwent seven-field fundus photography, which was used as the defined standard against which the clinical examinations were compared and also to determine the prevalence of DR. Data on age at diagnosis, duration of diabetes mellitus, recent HbA1c levels, treatment for systemic hypertension and microalbuminuria were obtained from medical records.
Results When compared with the defined standard, fundal examination with green light was more sensitive, more specific and had higher predictive values than examination with white light in the detection of early DR. The overall prevalence of DR was 44%, which in all cases was classified as minimal to mild background DR. Patients with DR had significantly higher mean HbA1c levels than those without (p = 0.016). There was no significant association between the prevalence of DR and age at time of examination or diagnosis, duration of diabetes, patient gender, microalbuminuria levels or treatment for systemic hypertension.
Conclusions Fundal examination with green light is better than white light in detecting early DR in juvenile diabetics with duration of disease of 10 years or more. Furthermore the presence of DR is associated with poorer diabetic control. Due to coincident lifestyle changes and the probability of long duration of disease, accurate detection of early DR in juvenile diabetics with diabetes for over 10 years is important.
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Dorchy H, Toussaint D, Devroede M, Ernould CH, Loeb H . Diagnostic de la retinopathie diabetique infantile par angiographic fluoresceinique. Nouv Press Med 1977;6:345–7.
Frank RN, Hoffman HH, Podgor MJ, Joondeph HC, Lewis RA, Margherio RR, et al. Retinopathy in juvenile-onset type I diabetes of short duration. Diabetes 1982;31:874–82.
Lund-Anderson C, Frost-Larsen K, Stamp K . Natural history of diabetic retinopathy in insulin-dependent juvenile diabetics. Acta Ophthalmol 1987;65:481–6.
Barta L, Brooser G, Molnar M . Fluorescein angiography of the fundus in juvenile diabetics. Ophthalmol Digest 1974;4:19–21.
Malone JI, Van Calder TC, Edwards WC . Diabetic vascular changes in children. Diabetes 1977;26:673–9.
Dorchy H, Toussaint D, Vanderschueren-Lodeweyckx M, Vandenbussche E, De Vroede M, Loeb H . Leakage of fluorescein: first sign of juvenile diabetic retinopathy. Role of diabetic control and of duration of diabetes. Acta Paediatr Scand Suppl 1979;277:47–53.
Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs: an extension of the modified Airlie House classification. ETDRS report no. 10. Ophthalmology 1991;98 (Suppl):786–806.
Sussman EJ, Tsiaris WG, Soper KA . Diagnosis of diabetic eye disease. JAMA 1982;247:3231–4.
Jerneld B, Algerve P . The prevalence of retinopathy in insulin dependent juvenile-onset diabetes mellitus: a fluorescein-angiographic study. Acta Ophthalmol 1984;62:617–30.
Moss SE, Klein R, Kessler SD, Richie KA . Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy. Ophthalmology 1985;92:62–7.
The Diabetes Control and Complications Trial Research Group. Color photography vs fluorescein angiography in the detection of diabetic retinopathy in the diabetes control and complications trial. Arch Ophthalmol 1987;105:1344–51.
Kinyoun J, Barton F, Fisher M, Hubbard L, Aiello L, Ferris F . Detection of diabetic macular oedema. Ophthalmoscopy versus photography. ETDRS report no. 5. Ophthalmology 1989;96:746–51.
Schachat AP, Hyman L, Leske MC, Connell AM, Hiner C, Javornik N, et al. Comparison of diabetic retinopathy detection by clinical examinations and photograph gradings. Arch Ophthalmol 1993;111:1064–70.
Pugh JA, Jacobsen JM, Van Heuven WAJ, Watters JA, Tuley MR, Lairson DR, et al. Screening for diabetic retinopathy: the wide-angle retinal camera. Diabetes Care 1993;16:889–95.
Lestradet H, Papoz L, Hellouin de Menibus CL, Levavasseur F, Besse J, Billaud L, et al. Long-term study of mortality and vascular complications in juvenile-onset (type I) diabetes. Diabetes 1981;30:175–9.
Botha JL, Parker H, Raymond NT, Swift PGF . Diabetes diagnosed before the age of 2 years: mortality in a British cohort 8-17 years after onset. Int J EpidemioI 1992;21:1132–7.
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL . The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520–6.
Agardh E, Torffvit O, Agardh CD . The prevalence of retinopathy and associated medical risk factors in type I (insulin-dependent) diabetes mellitus. J Intern Med 1989;226:47–52.
Guthrie GW . College, travelling and getting away from home. Diabetes Care 1978;1:126.
Schwartz LS, Coulson LR, Toovy D, Lyons JS, Flaherty JA . A biopsychosocial treatment approach to the management of diabetes mellitus. Gen Hosp Psychiatry 1991;13:19–26.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–86.
The Diabetes Control and Complications Trial Research Group. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol 1998;116:874–86.
WHO/IDF Europe. Diabetes care and research in Europe: the Saint Vincent Declaration. Diabet Med 1990;7:360.
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL . The Wisconsin Epidemiologic Study of Diabetic Retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984;102:527–32.
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Financial support: the Medical Council and the Research Foundation of the Royal Victoria Eye and Ear Hospital
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Cahill, M., Wallace, D., Travers, S. et al. Detection and prevalence of early diabetic retinopathy in juvenile diabetics with diabetes for 10 years or more. Eye 14, 847–850 (2000). https://doi.org/10.1038/eye.2000.234
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DOI: https://doi.org/10.1038/eye.2000.234