Re: Improving the patient decision making experience for cataract surgery during the COVID-19 era

Abstract

To characterize patients referred for diabetic retinopathy (DR) screening in a unique multidisciplinary diabetes care clinic at a tertiary care centre. A retrospective study was conducted involving patients who were referred to the Cardiac and Renal Endocrine Clinic (C.a.R.E. Clinic) at a tertiary care centre (University Health Network) for DR screening between April 2019 to March 2020 and November 2020 to August 2021. Patients' demographics, micro- and macro-vascular disease measurements, visual acuity, intraocular pressure, fundus imaging and Optical Coherence Tomography were collected and analyzed. Of the 64 patients that attended the C.a.R.E. clinic, 21 (33%) patients with type 2 diabetes had on-site DR screening. The remaining 43 patients had DR screening within 6 months of the appointment or were under Ophthalmology care with annual screening visits elsewhere. Of the 21 patients who underwent retinopathy screening, 7 (33%) had DR: 4 had mild non-proliferative DR (NPDR), 2 had moderate NPDR, 1 had proliferative DR, and 1 had macular edema. Patients with DR had a significantly longer diabetes duration compared to patients without DR (24.5±10.2 vs. 12.5±5.8 years, p=0.0247). No significant differences were observed in glycemic control, blood pressure, lipid profiles, kidney function, visual acuity, or intraocular pressure. Our analysis suggests a potential benefit of integrated DR screening for diagnosing and managing DR in patients with longstanding diabetes as part of a multidisciplinary diabetes care clinic. Future work is needed to further develop such clinics and investigate the long-term effect on patient outcomes.