Abstract
Background: Numerous well-known microvascular consequences of diabetes mellitus (DM), a systemic illness, include diabetic retinopathy (DR), neuropathy, and nephropathy. Lacrimal gland, cornea, and retina can all be affected by diabetes-related autonomic neuropathy. According to several studies, the prevalence of DR in young children ranges from 10% to 35%, however the risk of developing microvascular problems may rise during adolescence. Both the anterior and posterior parts of the eye can be impacted by diabetes mellitus (DM), a condition that has reached pandemic proportions. Even in affluent nations, diabetic retinopathy (DR) continues to be one of the main causes of blindness. Globally, it was estimated that 93 million people have DR and 28 million of those had DR that threatens their vision.
Aim: This study aims to investigate the diabetes-related ocular changes according to the glycosylated hemoglobin (HbA1c) level and duration of diabetes in children and compare the results with nondiabetic healthy children.
Material and Method: The Department of Ophthalmology undertook this prospective cross-sectional investigation. 42 consecutive Type 1 DM patients from a pediatric clinic of a state hospital were included in the study. The Ophthalmology Department consulted the patients as part of a program to screen for diabetic eye illness, and two youngsters were sent home because of their lack of cooperation during the examination. Thus, 40 kids with clinically confirmed Type 1 DM and 40 healthy, age- and gender-matched kids served as the study's controls. Each patient had an eye exam, a physical examination, and a review of their medical background and current medications. The following measurements were made: HbA1c level, best corrected visual acuity, intraocular pressure (IOP), central corneal thickness (CCT), tear break up time (BUT), Schirmer test, results of the dilated fundus examination, central retinal thickness (CRT), and total macular volume (TMV).
Results: The mean age of the patients with diabetes was 11.1 ± 2.1 years (mean ± SD, range: 4–18 years). The mean age of the healthy subjects was 11.22 ± 1.3 years. Twenty patients were male in the diabetic group (50 %), and 20 patients were female in the control group (50%). The mean duration of diabetes was 2.3 ± 2.1 (median was 3 years) and the mean HbA1c value was 8.5% ± 1.2% in the diabetic group. All eyes included in the analysis had a visual acuity of at least 20/20. Type 1 DM group exhibited significantly reduced Schirmer test, increased IOP, and decreased retinal thickness relative to the age-matched control group but no statistically significant difference was found for the BUT and for the CCT. The correlations between the age, duration, HbA1c, and IOP, BUT, Schirmer test, TMV, and CRT measurements did not reach statistical significance.
Conclusion: For the early diagnosis of problems, such as neuropathy-related DES, IOP abnormalities, and DR, more frequent screening may be beneficial. In order to track the development of DR, it is recommended that children with type 1 DM have at least an annual SD-OCT assessment of RNFL and macular thickness. For diabetic patients with long-term type 1 DM and/or greater HbA1c values, this period may be shortened. For the purpose of defining methods for the early diagnosis of pre-clinical retinopathy, additional prospective longitudinal comprehensive studies are required.
Keywords: Corneal thickness, Diabetic retinopathy, Dry eye syndrome, Type 1 DM.