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White spots in the central fundus in diabetic children and adolescents
1Department of Ophthalmology, University of Oulu, Finland.
Insights
Diabetic children may show tiny white spots in their fundus, similar to adults. These spots are often drusen deposits, not necessarily retinal pigment epithelium defects, indicating early diabetic eye changes.
Area of Science:
- Ophthalmology
- Pediatrics
- Diabetology
Background:
- Small retinal pigment epithelium defects, appearing as depigmented spots, are common in adult diabetic patients.
- The presence of these early changes in diabetic children remains unevaluated.
Purpose of the Study:
- To investigate the occurrence of fundus changes, specifically depigmented spots, in diabetic children.
- To determine if these spots are indicative of early retinopathy or other conditions like drusen.
Main Methods:
- Analysis of fundus photographs (black-and-white and color) from 206 diabetic children (aged 4.6-19.6 years).
- Comparison with a control group of 45 healthy children (aged 8.1-16.6 years).
- Assessment for early retinopathy signs and presence/number of white spots.
Main Results:
- Early retinopathy signs were observed in 13.1% of diabetic children.
- Tiny white spots were present in 47.1% of diabetic children and 53.5% of controls.
- Diabetic children with retinopathy had spots more frequently than those without (66.7% vs. 44.1%).
- Numerous spots were rare in both groups (4.4%).
Conclusions:
- Most white spots observed in the fundus of diabetic children likely represent drusen deposits.
- These findings suggest that while early retinopathy signs can occur, the common white spots may not be direct indicators of retinal pigment epithelium defects in this age group.
Abstract:
Previously, small defects in the retinal pigment epithelium appearing as depigmented spots in the fundus photographs have been observed in a high proportion of adult diabetic patients. In order to evaluate whether these changes already occur in children we examined the black-and-white and colour fundus photographs of 206 diabetic children aged 4.6-19.6 years (median 12.6), with the median duration of diabetes of 4.7 years (range 0.0-14.2). Early signs of retinopathy were observed in 27 (13.1%) of them. The control group was composed of 45 healthy children aged 8.1-16.6 years (median 11.8). One or more tiny white spots in the fundus of one or both eyes were observed in 97 diabetics (47.1%), more often in those with retinopathy than in those without (66.7% vs. 44.1%, p less than 0.001). In the control group similar spots were observed in 24 children (53.5%). Only in a small proportion of children (4.4% of both diabetic and control patients) were the spots numerous. In children most of the white spots in the fundus may represent drusen type deposits rather than defects in the pigment epithelium.