Diabetic retinopathy (DR) refers to retinal changes, which is a complication of Type 1 diabetes mellitus (DM) and is a major cause of blindness in young adults. As this disease may not have any symptoms and affect eyesight at an advanced stage, DR screening with accurate documentation of patient history and screening examinations via ophthalmology transcription can help physicians diagnose this condition at an early stage and provide timely treatment. The American Academy of Pediatrics recommends an initial screening at 3 to 5 years after diagnosing diabetes mellitus if the child is older than 9 years with annual-follow up thereafter. However, a new study suggests that DR screening should start later in children with diabetes mellitus.
In the opinion of the study co-author, though many young patients come for DR screening every year, they consistently show no sign of the disease. This study published in the journal Ophthalmology aimed at examining the prevalence and onset of ocular disease as well as its risk factors in children with diabetes. Children with below 18 years with type 1 or 2 DM were examined over a 4-year period. There were 370 children with a mean DM duration of 5.2 years, who had 693 examinations. No children had diabetic retinopathy while 12 children had cataract and 5 required extraction (identified by decreased vision, not diabetic screening). When 19 children had strabismus, 41 children had high refractive error. The study found no association between these conditions and duration or control of DM. The youngest age at diagnosis of severe DR was 15 years, and the shortest duration of disease was 5 years in literature.
The study concluded that DR is rare in children in spite of duration and control of DM and DR screening could begin at age 15 years or at 5 years after the diagnosis of DM, whichever occurs later, if the child is not at unusually high risk as judged by the endocrinologist. Existing amblyopia screening methods are effective for other ocular complications. Overall, the study recommends delayed screening regimen for asymptomatic children so that healthcare systems and families can avoid the extra burden of screening at a period when DR is not traceable.
While focusing on DR screening, you should give equal importance to your documentation. Ask for the symptoms of decreased vision or fluctuating vision, flashes of lights or defects in the field of vision and document them correctly in the patient’s history reports. Details regarding hemoglobin and blood pressure should be included as well. You should also document the results of physical examination (slit lamp examination and dilated fundus examination) performed. Apart from documenting screening examinations, update the medical documentation with details of follow-up examination for effective treatment.