The article on early retinopathy by Malone et al. (1) suggested that all newly diagnosed people with type 1 diabetes should have annual retinal examinations through a dilated pupil. The data to support this suggestion were taken from the Diabetes Control and Complications Trial (DCCT). The DCCT recruited subjects ≥13 years of age who were at least Tanner II stage for pubertal development. Therefore, the data do not apply to prepubertal children. Unfortunately, no such qualification was noted in their article or the accompanying editorial (2). Retinal changes are almost never present in children before puberty. I am concerned that Malone’s article will result in even more children than at present having regular ophthalmologic assessments that are entirely unnecessary. The American Diabetes Association recommends that children ≥10 years of age only need to have retinal examinations after 3–5 years, a time when most will have entered puberty (3). Perhaps a qualification should be noted in a future issue of Diabetes Care.

1.
Malone JI, Morrison AD, Pavan PR, Cuthbertson DD: Prevalence and significance of retinopathy in subjects with type 1 diabetes of less than 5 years’ duration screened for the Diabetes Control and Complications Trial.
Diabetes Care
24
:
522
–526,
2001
2.
Palmberg P: Screening for diabetic retinopathy (Editorial).
Diabetes Care
24
:
419
–420,
2001
3.
American Diabetes Association: Diabetic retinopathy (Position Statement).
Diabetes Care
24(Suppl. 1)
:
S73
–S76,
2001

Address correspondence to Robert M. Ehrlich, 381 Church St., Markham, Ontario L3P 7P3, Canada. E-mail: rerlich@sympatico.ca.