Dr. Ehrlich’s (1) point is well taken. The Diabetes Control and Complications Trial data did not include subjects under the age of 13 years. Our study (2) was not intended to deal with the subject of retinal exams for prepubertal children. Most physicians who care for children with diabetes agree with Dr. Ehrlich, who stated “retinal changes are almost never present in children before puberty.” This claim seems to overlook the Wisconsin Epidemiologic Study of Diabetic Retinopathy (3), a population-based study that reported that 4 of 26 children (15.4%) aged 0–9 years and 23 of 42 children (54.8%) aged 10–12 years, or 27 of 68 children (40%) aged 0–12 years, had retinopathy on retinal color photographs. This widely accepted study suggests that retinopathy does occur before puberty. If knowledge of the presence of microvascular disease in a patient is not important before it becomes vision-threatening, as suggested by Dr. Palmberg (4), then exams before puberty may be unnecessary. One should not believe, however, that microvascular disease does not exist in prepubertal children who have diabetes.
References
Address correspondence and reprint requests to John I. Malone, MD, Diabetes Center, Health Sciences Center, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 45, Tampa, FL 33612. E-mail: [email protected].
