Diabetic cataract at type 1 diabetes onset: frequency and characteristics

Pediatric diabetic cataract is a rare acute complication of diabetes mellitus and may result in permanent visual impairment. Reported prevalences range from 0.25 % to 3.4 %, while data from Germany remain limited. This study aimed to describe the prevalence and clinical characteristics of cataract in children with newly diagnosed type 1 diabetes at a German tertiary medical center.

We retrospectively evaluated children and adolescents admitted to the Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, with newly diagnosed type 1 diabetes between January 2008 and February 2024 who underwent ophthalmologic screening at the Department of Ophthalmology of the same center. A final cohort of 141 patients was analyzed.

Cataract was diagnosed in 6 of 141 patients, corresponding to 4.3 % of the ophthalmologically examined cohort. The median age of patients with cataract was 12.4 years. Mean HbA_1c was significantly higher in patients with cataract than in those without cataract (15.8 % vs. 12.4 %; p<0.05). Visual acuity was significantly lower in patients with cataract than in those without cataract (0.19 vs. 0.03 logMAR; p<0.05). The predominant morphology was snowflake-like posterior subcapsular cataract. Retinal findings were normal in all patients, irrespective of cataract status.

In this single-center cohort of screened children with newly diagnosed type 1 diabetes, cataract was detected more frequently in our ophthalmologically examined cohort than previously reported. Pediatric diabetic cataract may be underdiagnosed at diabetes onset. Initial ophthalmologic evaluation in children and adolescents with new-onset type 1 diabetes should, therefore, include slit-lamp examination, especially in patients with visual symptoms or markers of prolonged hyperglycemia.