Cataract in children with type 1 diabetes: a single-center experience from North India on an underrecognized complication

Objectives Consensus guidelines recommend cataract screening, along with a comprehensive eye evaluation, based on symptoms or at the time of screening for retinopathy in type 1 diabetes (T1D). This study evaluated the prevalence of cataract in T1D children and factors associated with it in resource-limited settings. Methods We conducted a retrospective, hospital-based observational study at a tertiary care center in North India, analyzing children with T1D who developed cataracts between April 2015 and March 2025. Clinical, anthropometric, biochemical, and ophthalmologic data were extracted from medical records. Results Of 1776 children diagnosed with T1D in the study period, 21 (1.18 %) developed cataracts. The median age at diabetes diagnosis was 7.7 years, and cataract diagnosis occurred at a median age of 9.9 years. Bilateral involvement was universal. Cataracts were present at the time of diagnosis of diabetes in 14.2 % and developed within the first year (early cataract) in 28.6 %. Posterior subcapsular cataract was the most common morphology. Notably, 38.1 % had Mauriac syndrome, all of whom developed cataracts later in the disease course, with significantly lower c-peptide levels. A strong negative correlation existed between baseline HbA1c and cataract onset interval (r=−0.468, p=0.032). Six children improved with glycemic control alone, while 10 underwent surgery. Conclusion Cataracts in children with T1D can occur early and may reflect poor metabolic control or autoimmune triggers. Screening should be considered at diagnosis and within the first year. Our findings underscore the need for region-specific guidelines to facilitate early detection and management of this vision-threatening yet treatable complication.