K: The case for biennial retinopathy screening in children and adolescents.Diabetes Care 28:509–513

OBJECTIVE — Current guidelines recommend annual retinopathy screening 2 years after onset (for pubertal-onset type 1 diabetes) and after 5 years (or age 11, whichever is earlier) for prepubertal onset. Our aim was to describe the natural history of retinopathy and to explore optimal retinal screening intervals for children and adolescents (aged 20 years) screened according to these guidelines. RESEARCH DESIGN ANDMETHODS — More than 1,000 children and adolescents, followed longitudinally, were screened for retinopathy using seven-field stereoscopic fundus photography through dilated pupils. Of these, 668 had baseline and follow-up retinal screening. Using generalized estimating equations, we compared the risk of retinopathy with baselines at yearly intervals, in older and younger groups, in higher risk groups (diabetes duration10 years or HbA1c 10 % at any screening), and after stratification 10 and 10 years in duration. RESULTS — After 1 year, retinopathy did not increase significantly in the older group (n 618, median HbA1c 8.7%, range 8.0–9.5), younger group (n 50, median HbA1c 8.5%, range 8.0–9.2), or the higher-risk groups. Retinopathy increased significantly after 2 years in the older group (P 0.003) but not until 6 years in the younger group (P 0.01). In the group wit