Type 1 and 2 diabetes in children and adolescents globally has a peak onset at 11 to 12 years of age. Diabetic retinopathy is a complication of diabetes, which can damage the tiny blood vessels inside the retina at the back of the eye and can cause severe vision loss and blindness by the time a person reaches their 20s.
It is recommended that children with type 1 diabetes are screened for diabetic retinopathy five years after they are first diagnosed, and regularly thereafter. Most children will not display any symptoms until irreversible retinal structural damage has already occurred in the form of microaneurysms and haemorrhages, which is why screening is key to tackling this major health concern.
The Perron Paediatric Retinopathy Initiative is both a clinic and a research facility which is transforming the way diabetes-related vision loss is managed in Western Australian children.
Early detection at new screening clinic
In 2019, only 20 per cent of children in Western Australia were meeting the guidelines for diabetic retinopathy screening. In other words, up to 80 percent were not being screened in a timely way.
In 2021, the Lions Eye Institute under the leadership of Professor Chandra Balaratnasingam, established the state’s first screening and treatment clinic for children with diabetes, called the Perron Paediatric Retinopathy Initiative. Since its inception, over 80 per cent of children in Western Australia are now meeting screening guidelines.
In collaboration with Perth Children’s Hospital and Diabetes WA, at risk patients are identified and immediately referred to the Lions Eye Institute’s paediatric screening clinic. At the first signs of diabetic retinopathy, patients are provided with a management and treatment plan. So far, over 200 patients have been screened.
Complementary research to identify new ways to detect diabetic retinopathy
Traditionally, colour photography is the main tool for screening diabetic retinopathy, however, it lacks resolution and our aim through research and screening is to detect disease much earlier than changes that can be seen in colour photography.
Image of retinal capillaries and diabetic retinopathy
Professor Balaratnasingam has teamed up with Professor Dao-Yi Yu AM to also use optical coherence tomography angiography (OCTA) – a non-invasive imaging technique, to determine if it’s feasible to detect very early-stage retinal microvascular dysfunction in children with type 1 and type 2 diabetes. We also aim to detect kidney disease using measures of retinal perfusion.
As well as following children with type 1 and type 2 diabetes, the study will also follow a healthy cohort of children as a comparison, collecting annual data over a period of five years. We are collaborating with researchers at The University of Western Australia and Perth Children’s Hospital. The hope is to identify new imaging-based biomarkers that will pinpoint retinal damage from diabetes at an earlier stage than is currently possible.
