Abstract
PurposeThe aim of this study was to determine whether social deprivation is a risk factor for late presentation of patients with proliferative diabetic retinopathy and whether it affects their access to urgent laser treatment.MethodsUsing a 2:1 case: control design, 102 patients referred to a UK teaching hospital as part of the UK Diabetic Retinopathy National Screening Programme were identified for the period between 1 June 2010 to 1 June 2013. Social deprivation was scored using the Index of Multiple Deprivation 2010. Additional variables considered included age, duration of disease, ethnicity, and HbA1c at time of referral.ResultsThe cases comprised 34 patients referred with proliferative (grade R3) retinopathy with a control group of 68 patients with lower retinopathy grades; two control patients were excluded due to incomplete data. On univariate analysis, R3 retinopathy was associated with higher social deprivation (P<0.001, Mann–Whitney U-test), and with higher HbA1c (11.5% vs 8.4%; P<0.001, Mann–Whitney U-test). Forward stepwise multivariable analysis showed that the association of R3 retinopathy with deprivation was significant even after adjusting for HbA1c (P=0.016). On univariate analysis South Asian ethnicity was also identified as being a risk factor for presentation with R3 retinopathy, but this was no longer significant when HbA1c was adjusted for in a forward stepwise logistic regression analysis.ConclusionIn our cohort social deprivation appears to be associated with late presentation of proliferative diabetic retinopathy. Our study supports the need to target these groups to reduce preventable blindness and to identify strategies which overcome barriers to care.
Highlights
Diabetic retinopathy is the leading cause of blindness in the UK’s working-age population[1] and has been estimated to cause “legal” blindness in 1,280 people per year in the UK.[2]
From the period 1 June 2010 to 31 May 2013 as part of a service evaluation we identified all consecutive patients referred with R3 retinopathy that had been confirmed by an ophthalmologist according to national screening criteria.[8,9,12]
One hundred and two “new” patients were included in this study: 34 consecutive patients presenting with R3 retinopathy and 68 “date-matched” controls with non-R3 diabetic retinopathy presenting over the same time period; all patients were referred via the diabetic screening service
Summary
Diabetic retinopathy is the leading cause of blindness in the UK’s working-age population[1] and has been estimated to cause “legal” blindness in 1,280 people per year in the UK.[2]. Of the various retinopathy grading systems that exist, the one adopted by the National Health Service Diabetic Eye Screening Programme within England consists of three stages:[4,5,6,7,8] R1, R2, and R3. R1 (background) retinopathy consists of microaneurysm formation, retinal hemorrhages and cotton wool spots. The additional presence of venous beading, venous reduplication and intraretinal microvascular abnormalities are indicative of R2 (pre-proliferative) retinopathy. The classification of R3 (proliferative) retinopathy is reserved for advanced disease when there are new vessels present on the disc or elsewhere, and may include pre-retinal or vitreous hemorrhages, or pre-retinal fibrosis.[9] Maculopathy is classified separately
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