In children with an average diabetes onset at 11 y of age, the first r
etinal changes can be expected after a median diabetes duration of 9 y
, while the median time until clinically relevant background retinopat
hy is 14 y. Periodic examinations of the retinal status become necessa
ry with the onset of puberty or after 5 y of diabetes duration. Only s
ensitive methods should be used for retinopathy screening; the minimum
recommended standard is a stereoscopic slit-lamp biomicroscopic exami
nation in mydriasis. The degree of glycaemic control, both before and
after puberty, appears to be of outstanding importance for the develop
ment of retinopathy, but the contribution of other factors (arterial b
lood pressure, lipid abnormalities, sex steroids, smoking and genetic
factors) may be of varying relevance in the individual patient. Thus,
to improve the long-term prognosis for children with diabetes appropri
ate screening for retinopathy and associated risk factors is mandatory
.