Referral Time for Diabetic Retinopathy Screening and Impact on the Visual Acuity of Patients in a Tertiary Hospital

Abstract

OBJECTIVE: To evaluate the referral time for the screening of diabetic retinopathy (DR) from the initial diagnosis of diabetes to retinal examination. We also compared visual results among groups screened at various duration of referral time.METHODS: This cross-sectional study was conducted retrospectively from medical records for the poorer-seeing eyes of 100 patients with type 2 diabetes from January 2021 to December 2022 at the tertiary eye center. Patients were classified based on the time duration from the initial diagnosis of diabetes to retinal examination or imaging. Visual acuity (VA) and DR stages categorized by the period of referral time were compared among each group.RESULTS: Seventy-five patients (75%) took > 2 months from the first diagnosis of diabetes to DR screening performed by an ophthalmologist. Twenty-three patients (23%) were diagnosed with DR at the first ophthalmic visit; among these, 16 had a referral time of > 2 months. Twelve patients were diagnosed with vision-threatening DR; six of these had diabetic macular edema. The receiver operating characteristic (ROC) curve analysis indicates that patients receiving ophthalmic examination within 91 days from the diagnosis of diabetes likely maintain a best-corrected VA of ≥ 20/50. This recommended period of referral time yielded an area under the ROC curve, sensitivity, and specificity of 70.63%, 61.90%, and 83.33%, respectively.CONCLUSION: In clinical practice, a prolonged period for the first DR screening is relatively common and may result in more patients with vision-threatening DR. Proactive and systematic work should be undertaken to create patient awareness on the importance of detection of asymptomatic and early-stage DR to prevent irreversible visual loss.