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Macular recovery during onset and development of diabetic retinopathy in childhood and adolescence
K Frost-Larsen1, C Lund-Anderson, K Starup
1Department of Ophthalmology, Gentofte Hospital, University of COpenhagen, Denmark.
Insights
Nyctometry, measuring macular recovery time, showed lower initial values in children who later developed proliferative diabetic retinopathy. However, its predictive accuracy is limited for identifying at-risk youth.
Area of Science:
- Ophthalmology
- Endocrinology
- Diabetology
Background:
- Insulin-dependent diabetes mellitus (IDDM) poses risks for retinopathy in children.
- Early detection of diabetic retinopathy progression is crucial for timely intervention.
Purpose of the Study:
- To investigate the relationship between macular recovery time (MRT) measured by nyctometry and retinal findings in children with IDDM.
- To assess the clinical applicability of nyctometry in identifying children at risk for proliferative diabetic retinopathy (PDR).
Main Methods:
- A 6-year longitudinal study of 60 pre-pubescent children with IDDM.
- Macular recovery time (nyctometry) and retinal findings were recorded initially and throughout the study.
- Patients were monitored for the development of retinopathy, including PDR.
Main Results:
- Nearly all participants (93%) developed retinopathy during the study.
- 14% progressed to proliferative diabetic retinopathy.
- Children who developed PDR had significantly lower initial macular recovery times (616 ± 95 ms) compared to those who did not (900 ± 47 ms).
- Predictive sensitivity for PDR was low (56%) at 90% specificity due to high variation.
Conclusions:
- While initial nyctometry results differed between those who did and did not develop PDR, its predictive value in children is limited.
- Nyctometry appears less suitable for selecting at-risk pediatric patients for PDR compared to adults.
Abstract:
The relationship between the macular recovery recorded by nyctometry and the retinal findings was examined in 60 initially pre-pubescent children with insulin-dependent diabetes mellitus during a 6-year period with special reference to the clinical applicability of nyctometry in selecting children and adolescents at risk of developing proliferative diabetic retinopathy. At the end of the study period the mean age of the patients was 21.9 years (range 18-23 years) and the mean diabetes duration 13.2 years (range 8.1-21.2 years). At the initial recording of macular recovery, only 7% of the children showed retinopathy, and this only in the form of a few microaneurysms or dot haemorrhages. During the study period, however, nearly all (93%) developed retinopathy, and in 9 (14%) the disease progressed into proliferative retinopathy. The initially recorded macular recovery time (MRI) of those children developing proliferative retinopathy was significantly lower (616 +/- 95; X +/- SEM) compared to the initial MRT performances (900 +/- 47) of the rest of the children. However, due to a high coefficient of variation in the material; predictive sensitivity showed low (56%) at a specificity level of 90%, suggesting that nyctometry is less suitable for selecting risk patients in children than in adults.