Metabolic cataract was the most frequent ocular complication in children with T1DM. Findings presented at the 51st Annual Conference of the International Society for Pediatric and Adolescent Diabetes (ISPAD) described a cross-sectional study evaluating diabetic retinopathy, metabolic cataract, and glaucoma in pediatric diabetes.

The study enrolled 118 consecutive patients aged ≤21 years between October 2023 and January 2024 at a tertiary hospital. Comprehensive ophthalmic evaluation included fundus slit-lamp examination and measurement of intraocular pressure. Glycemic control was assessed using glycated hemoglobin (HbA1c). Logistic regression was used to analyze risk factors.

Metabolic cataract was identified in 4.2% of participants, exceeding the prevalence of diabetic retinopathy at 3.4%. All retinopathy cases were mild non-proliferative. Glaucoma was detected in 0.8% of patients. Early onset was notable, as 60% of cataract cases occurred in patients with a diabetes duration of less than 5 years. Poor glycemic control was common, with 93% of patients having HbA1c ≥7% and a mean HbA1c of 10%.

Poor glycemic control was significantly associated with metabolic cataract (adjusted odds ratio [AOR] 1.86; 95% confidence interval [CI] 1.09–3.16). It was also associated with diabetic retinopathy (AOR 2.1; 95% CI 1.01–4.39). 

These findings show that metabolic cataract can develop early in pediatric T1DM. Although glaucoma was rare, its presence alongside cataract and retinopathy supports comprehensive ocular screening rather than retinopathy-focused assessment alone.