====== Diabetic Retinopathy in Children ======
  * Uncommon in young children 
  * Microvascular complications  may become evident in adolescence
    * 3-6% of Type I diabetes
    * 9-10% in Type II diabetes
  * Non-proliferative and vision-threatening retinopathy is rare before age 12 
====Recommendations for Eye Screening in Children with Diabetes====
  * American Diabetes Association
    * Comprehensive eye examination after they have had diabetes for 3-5 years if ≥ 11 years of age or puberty has started whichever is earlier 
    * Repeat dilated and comprehensive exams every 2 years
    * Repeat exams can be less frequent (up to every 4 years) if A1C <8% 
  * American Academy of Ophthalmology
    * For Type I Diabetes
      * First eye exam 5 years after onset of diabetes then annually thereafter
    * For Type II Diabetes
      * First eye exam at the time of diagnosis then annually thereafter 
====Ocular manifestations possible in Children====
===Non-proliferative retinopathy===
^ Stage        ^ Fundus Findings                                                                                                                     ^ Progress of Risk to Proliferative Retinopathy  ^
| Mild         | Microaneurysms only                                                                                                                 | 6% at 5 years                                  |
| Moderatge    | Microaneurysms + hemorrhages, hard exudates, cotton wool spots, venous beading, or IRMA                                             | 18% at 5 years                                 |
| Severe       | 4-2-1 rule (any of the following);hemorrhages in all 4 quadrants, venous beading in ≥2 quadrants, or prominent IRMA in ≥1 quadrant  | 50% in 1 year                                  |
| Very-Severe  | Two or more of the Severe features above                                                                                            | 100% at 4 years in one series                  |
===Proliferative retinopathy===
  * Early PDR 
    * new extraretinal vessels usually around the optic nerve (NVD) and retina (NVE)
  * High Risk PDR
    * NVD > 1/3 disc diameter 
    * NVD or NVE of any size with vitreous or pre-retinal hemorrhage 
  * Leads to tractional retinal detachment 
  * Neovascularization of the iris/angle  can lead to neovascular glaucoma 
  * 50% left untreated will have profound vision loss 
===Diabetic macular edema===
  * Important cause of vision loss associated with capillary non-profusion

====References====
  - [[https://pmc.ncbi.nlm.nih.gov/articles/PMC10725814 |Children and Adolescents: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S283-S305. doi:10.2337/dc25-S014.]]
  - [[https://pubmed.ncbi.nlm.nih.gov/31757498/ |Diabetic Retinopathy Preferred Practice Pattern®. Flaxel CJ, Adelman RA, Bailey ST, et al. Ophthalmology. 2020;127(1):P66-P145.]]
  - [[https://pubmed.ncbi.nlm.nih.gov/34902076/ | Pediatric Diabetic Retinopathy: Updates in Prevalence, Risk Factors, Screening, and Management. Lin T, Gubitosi-Klug RA, Channa R, Wolf RM. Current Diabetes Reports. 2021;21(12):56.]]
  - [[https://pubmed.ncbi.nlm.nih.gov/14693935/ |Retinopathy in Diabetes. Fong DS, Aiello L, Gardner TW, et al. Diabetes Care. 2004;27 Suppl 1:S84-7.]]