Non-proliferative Retinopathy Research Articles

Safety of transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema in eyes with good visual acuity.

To determine the safety of transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema. The records of all patients treated with transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema in two retina clinics were reviewed. The eligibility included fovea-involving diabetic macular edema by spectral domain optical coherence tomography and pretreatment visual acuity of 20/40 or better. Thirty-nine eyes of 27 patients aged 50 years to 87 years (mean, 69 years) were included. Postoperative follow-up ranged from 3 months to 36 months (mean, 11 months). Fourteen patients were insulin dependent, and 19 had nonproliferative retinopathy. The preoperative visual acuity was 20/20 (10 eyes), 20/25 (10 eyes), 20/30 (8 eyes), and 20/40 (11 eyes). No eye had evidence of laser-induced macular damage by any imaging means postoperatively. There were no adverse treatment effects. Logarithm of the minimum angle of resolution visual acuity was improved on average of 0.03 units at 4 months to 7 months of follow-up (P = 0.0449, paired t-test) and otherwise stable. The central foveal thickness was improved at 4 months to 7 months (P = 0.05, paired t-test) and 8 months to 12 months, postoperatively (P = 0.04, mixed model accounting). Maximum macular thickness was improved at 4 months to 7 months postoperatively (P = 0.01, paired t-test and mixed model accounting). In a small retrospective series, transfoveal subthreshold diode micropulse laser was safe and effective for the treatment of fovea-involving diabetic macular edema in eyes with good preoperative visual acuity that were not the candidates for conventional photocoagulation or intravitreal injection. Further study is warranted.

Sight-threatening diabetic eye disease: an update and review of the literature.

Diabetic eye disease is the third most important cause of visual loss in England and Wales, after age-related macular degeneration and glaucoma.1 In contrast to the first two, the evidence shows that effective treatment for diabetic eye disease begins not in the eye clinic, but in the GP practice. Vision-threatening consequences of diabetes include proliferative retinopathy and maculopathy. Proliferative retinopathy may cause vitreous haemorrhage and retinal detachment with catastrophic loss of vision. Maculopathy refers to oedema at the macula, secondary to retinal capillary leakage, with consequent loss of central visual acuity. In the UK, all patients with diabetes who are not already under the care of the eye clinic should be enrolled in a retinopathy-screening programme.2 Patients are referred to an ophthalmologist if there is evidence of proliferative or pre-proliferative retinopathy or maculopathy. Letters about the patient will refer to the retinopathy grade, which is potentially bewildering, but can be readily decoded (Table 1). In the English system, the retinopathy grades R1, R2, and R3 are equivalent to ‘background’, ‘pre-proliferative’, and ‘proliferative’. The Scottish system is different and incorporates three grades of non-proliferative retinopathy.2 Therefore, (in the English system; Table 1) a patient graded ‘R2 M1 P0’ will have pre-proliferative retinopathy, evidence of maculopathy, and no visible photocoagulation scars. View this table: Table 1. Making sense of the diabetic patient’s screening letter …

Higher dietary salt intake is associated with microalbuminuria, but not with retinopathy in individuals with type 1 diabetes: the EURODIAB Prospective Complications Study.

Aims/hypothesisHigh dietary salt intake has been associated with elevated BP and may also have a deleterious effect on microvascular complications. We studied the cross-sectional associations between dietary salt intake (estimated from 24 h urinary sodium excretion) and urinary potassium excretion on the one hand, and the prevalence of microvascular complications on the other, in individuals with type 1 diabetes.MethodsWe measured sodium and potassium concentrations in two 24 h urine samples in 1,212 individuals with type 1 diabetes (40 ± 10 years old, 51% men) who participated in the EURODIAB Prospective Complications Study. We used multiple logistic regression analyses to investigate associations between dietary salt intake and microvascular complications adjusted for age and sex, and additionally for BMI, smoking, urinary potassium excretion, antihypertensive medication and physical activity, and total energy, protein, alcohol, saturated fat and fibre intake.ResultsAfter full adjustment, 1 g/day higher dietary salt intake was positively associated with the presence of microalbuminuria (OR 1.06 [95% CI 1.01, 1.10]), but not macroalbuminuria (OR 0.99 [95% CI 0.94, 1.05]), non-proliferative retinopathy (OR 1.00 (95% CI 0.96, 1.04]) or proliferative retinopathy (OR 1.02 (95% CI 0.95, 1.08]). After excluding individuals with cardiovascular disease and/or antihypertensive medication (n = 418), we found a non-significant association with microalbuminuria (OR 1.04 [95% CI 0.99, 1.10]) and macroalbuminuria (OR 1.05 [95% CI 0.96, 1.16]). The association between dietary salt intake and microalbuminuria was stronger in individuals with a BMI above 25 kg/m2 (OR 1.11 [95% CI 1.04, 1.18]) than in those with BMI below 25 kg/m2 (OR 1.03 [95% CI 0.97, 1.09]). No significant associations were found between urinary potassium excretion and microvascular complications.Conclusions/interpretationIn individuals with type 1 diabetes, higher dietary salt intake, as determined by 24 h urinary sodium excretion, may be positively associated with microalbuminuria, particularly in overweight individuals.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-014-3367-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

The predictive role of markers of Inflammation and endothelial dysfunction on the course of diabetic retinopathy in type 1 diabetes

AimsThis study was undertaken to determine whether levels of inflammation and endothelial dysfunction biomarkers in serum samples collected at baseline in the Diabetes Control and Complications Trial (DCCT) cohort could predict the development of retinopathy. MethodsLevels of clotting/fibrinolysis, inflammation and endothelial dysfunction biomarkers were measured in 1391 subjects with type 1 diabetes to determine whether their levels predicted increased risk to develop or accelerate progression of retinopathy during 16years of follow-up. ResultsUsing regression models adjusted for DCCT treatment group, duration of diabetes, baseline retinopathy scores, HbA1c and albumin excretion rate, the baseline levels of sE-selectin and PAI-1 (active) were significantly associated with increased risk of a 3-step progression in retinopathy score in the primary prevention cohort (PPC). After adjusting for additional covariates (e.g., ACE/ARB and statin therapy), this association persisted. Levels of active and total PAI-1 in the same group were also significantly associated, after similar adjustments, with the time to progress to severe non-proliferative retinopathy during the follow-up period (54 and 29%, respectively of increased risk). No associations were observed in the secondary intervention cohort for any of the outcomes. ConclusionsHigh levels of sE-selectin and PAI-1 are associated with the development of retinopathy in patients with uncomplicated type 1 diabetes.

Serum uric acid concentration is associated with worsening in severity of diabetic retinopathy among type 2 diabetic patients in Taiwan—A 3-year prospective study

AimsTo explore the role of serum uric acid (SUA) concentration in diabetic retinopathy (DR) for patients with type 2 diabetes mellitus (T2DM). MethodsA 3-year prospective study in 749 patients with T2DM and without proliferative diabetic retinopathy (PDR) was conducted at a medical center. Baseline SUA concentration and parameters of glycemic control, blood pressure, kidney disease, and lipid profiles were analyzed to determine their contribution to DR. ResultsFundus examination showed that 184 patients (24.6%) had non-proliferative retinopathy and 565 (75.4%) without DR at baseline. After 3 years, increase in the severity of DR was recognized in 103 patients (13.8%), including 81 patients with newly developed DR. Patients with increase in severity of DR positively associated with duration of DM (11.9 vs. 9.4 years, p=0.001), HbA1c (7.6 vs. 7.2%, p=0.001), albuminuria (45.5 vs. 31.0%, p=0.006), and SUA (6.47 vs. 5.87mg/dl, p<0.001) than did those without change in DR stage. Cox regression showed that patients with SUA in the 3rd (5.9–6.9mg/dl) and 4th (≥7.0mg/dl) quartiles had hazard ratios for DR worsening of 2.57 and 3.66 (95% C.I. 1.30–5.08 and 1.92–7.00) when compared with patients with SUA in the 1st quartile (<4.9mg/dl). ConclusionsSUA concentration is associated with the increase in severity of DR over a 3-year period in patients with T2DM. Further study is required to define the exact role of SUA in DR.

The Endothelium in Diabetic Nephropathy

Diabetes is characterised by widespread endothelial cell dysfunction that underlies the development of both the micro- and macrovascular complications of the disease, including nephropathy, cardiomyopathy, and non-proliferative retinopathy. In the kidney, major changes are noted in glomerular endothelial cell structure in their fenestrations and glycocalyx. These changes, along with endothelial cell loss and capillary rarefaction in both the glomerulus and tubulointerstitium, lead to the progressive loss of glomerular filtration that render diabetes the most common cause of end-stage renal disease in much of the developed world. New treatments in diabetes that directly address the abnormal structure and function of the endothelial cell are desperately needed.

Direct Medical Costs for Complications Among Children and Adults with Diabetes in the US Commercial Payer Setting

Complications associated with diabetes are a major contributor to the burden of the disease. To better inform decision modelling, there is a need for cost estimates of specific diabetes-related complications, stratified by diabetes type and patient age group. To obtain direct medical costs of managing and treating diabetes-related complications over a 2-year period, for adults and children with type1 diabetes mellitus (T1DM) or type2 diabetes mellitus (T2DM), using data from a large commercially insured US subscriber database. We examined records from a large US multi-payer claims database to identify patients with any diabetes-related complications included in nine pre-specified categories, filed between January 2009 and September 2010, and with pre-index evidence of T1DM or T2DM. Patients were required to have continuous health plan enrolment 12months before and 24months after each index complication. Patients were classified into cohorts based on their diabetes type and age status at the time of the complication. The direct medical cost associated with each complication was calculated for the 12- and 24-month follow-up periods. Mean paid and allowed total costs were calculated and inflation-adjusted to the year 2011. Of the 119,715 patients who met the inclusion criteria, 211 (0.2%) were categorized as children with T1DM, 55 (0.05%) as children with T2DM, 6,227 (5.2%) as adults with T1DM and 113,222 (94.6%) as adults with T2DM. The respective mean cohort ages were 13.5, 14.9, 48.5 and 58years. Proteinuria/albuminuria was the most common complication for T1DM and T2DM child cohorts, with this complication occurring in almost one third of these children. Among the child cohorts, renal disease accounted for the highest mean paid cost for T1DM patients (US$6,053) whereas for T2DM patients, the complication associated with the highest mean paid cost was lactic acidosis (US$25,053). For the adult T1DM cohort, the complications with the highest occurrence and highest mean total paid cost were non-proliferative retinopathy (40.3%) and renal disease (US$28,076), respectively. Similarly, for the adult T2DM cohort, these complications were neuropathy (26.8%) and peritoneal dialysis (US$32,826). With the continuing and increasing interest in child and adult T1DM and T2DM, stakeholders will need relevant and timely information to guide treatment decision making. This cost research may directly inform the economic models that are often developed to better identify, understand and manage key economic considerations that drive the costs of this chronic disease.

Incidence and Progression of Diabetic Retinopathy During 17 Years of a Population-Based Screening Program in England. Diabetes Care 2012;35:592–596

In the print version of the article listed above, in the results section of the abstract, the sentence“Among those with nonproliferative (background) retinopathy at baseline, after 1 year 23% developed preproliferative retinopathy, 5.2% developed maculopathy, and 6.1% …

Formation of microvascular complications in patients with slowly progressive autoimmune diabetes in adults

The examination of 261 patients with slowly progressive autoimmune diabetes of adults (LADA), diabetes mellitus type 1 and 2 with an average duration of disease 3,41±0,13 years not found a significant difference in the frequency of non-proliferative and preproliferative retinopathy, as well as microalbuminuria. Expressed microvascular complications (proliferative retinopathy, proteinuric stage of nephropathy) were detected only in patients with slowly progressive autoimmune diabetes of adults. In these patients an association was established reliable relationship between the development and progression of nephropathy and retinopathy. The factors influencing the development of retinopathy in these patient were defined as the time from the onset of complaints and the time since diagnosisis was established, and the time of until insulin prescription as from the time of the first complaint, and after diagnosis establishment. In the case of diabetic retinopathy development the effect of these factors on the progression of this complication disappears.

Ocular manifestations in egyptian children and young adults with sickle cell disease.

In sickle cell disease (SCD), ocular lesions result from stasis and occlusion of small eye vessels by sickled erythrocytes. Vaso-occlusive disease of the retina can be responsible for nonproliferative (NPR) and proliferative retinopathy (PR). Patients are often asymptomatic until serious complications arise as, vitreous hemorrhage and retinal detachment. This work aimed to study the frequency and pattern of ocular manifestations in Egyptian children and young adults with SCD. In this cross-sectional study, 40 steady state patients (80 eyes) aged 2-28years (30 children and 10 young adults) with established diagnosis of SCD (26 with homozygous SS and 14 with S/β thalassemia underwent complete ophthalmic examination with dilated fundoscopy. Fluorescein angiography was performed for patients ≥12years old. The overall frequency of retinal lesions was 47.5% (46.2 and 50% of SS and S/β patients respectively). PR and NPR were evident in 32.5 and 27.5% of all enrolled patients respectively (five patients having both). Peripheral retinal occlusion was a frequent ocular finding in both groups; the youngest patient showing PR was 15years old. Older age, longer disease duration and splenectomy were significantly more prevalent among patients with PR. Despite lack of visual symptoms, children and young adults are at risk of PR. Frequency of retinal lesions was comparable in SS and S/β patients. Periodic ophthalmologic examination starting at the age of 12years is recommended for timely-identification of retinal lesions thus minimizing the risk of sight threatening retinopathy.

Homocysteine serum levels in diabetic patients with non proliferative, proliferative and without retinopathy.

Homocysteine has been associated with extracellular matrix changes. The diabetic retinopathy is a neurovascular complication of diabetes mellitus and it is the leading cause of vision loss among working adults worldwide. In this study, we evaluate the role of homocysteine in diabetic retinopathy analyzing the plasma levels of homocysteine in 63 diabetic type 2 patients with nonproliferative retinopathy (NPDR), 62 patients with proliferative diabetic retinopathy (PDR), 50 healthy subjects used as control group, and 75 randomly selected patients.

Influence of diabetes mellitus on corneal thickness

Ultrastructural changes in corneas of patients with diabetes mellitus have been previously described. The aim of this study was to compare central corneal thickness (CDR) values in diabetic patients without retinopa- thy at the stage of diabetic nonproliferative and proliferative retinopathy and CDR in a control group of healthy subjects. The study included 121 diabetic patients and 125 healthy subjects matched according to gender and age. Each patient underwent ophthalmological examination involving a dilated fundus examination and CDR measurement using the ultrasound pachymeter. The eyes of diabetic patients were classified according to Early Treatment Diabetic Retinopathy Study into three groups: without diabetic retinopathy (NDR), with nonproliferative diabetic retinopathy (NPDR) and a group with proliferative diabetic retinopathy (PDR). Only one eye of each subject was chosen for the study. The mean CDR value was significantly higher in the diabetic group (570.52 ± 31.81 μm) compared with the control group (541.42 ± 27.82 μm). The difference between the two groups was statistically significant (p<0.0001). The highest mean CDR value was recorded in the PDR group (585.97 ± 28.58 μm), followed by the NPDR group (570.84 ± 30.27 μm), whereas the lowest mean CDR value was recorded in the NDR group (559.80 ± 31.55 μm). There was a statistically significant difference in CDR between the NDR and PDR groups, as well as between the NPDR and PDR groups (p < 0.001, p < 0.05 respectively). No significant difference was recorded between the NDR and NPDR groups (p>0.05). CDR of diabetic patients was higher compared to healthy subjects. The highest mean value of CDR was registered in the PDR group, followed by the NPDR and the NDR groups.

Evaluation of diabetic retinopathy screening using a non-mydriatic retinal digital camera in primary care settings in south Israel

To evaluate the effectiveness of the non-mydriatic digital camera for diabetic retinopathy (DR) screening. Secondary purposes of the study were to characterize diabetic patients being screened for the presence of DR and to calculate the sensitivity, specificity, and positive predictive value of the test. All 6,962 consecutive patients with type 2 diabetes undergoing non-mydriatic digital retinal photography between January 1, 2009 and June 30, 2010 in eight community health clinics in the south of the country were included. Comparison of a random sample of patients who underwent non-mydriatic retinal photography, and who were also examined by an ophthalmologist with pupil dilation was also performed. The average age of all patients was 64.2 years. A total of 5,960 cases (85.6 % of all photographs) were of adequate quality for the diagnosis. DR of any degree was found in 1,092 (18.3 %) patients. Normal fundus pictures were found in 49.4 % of patients. In 32.2 % of cases, non-DR pathologies were found. Among cases in which DR was found, 73.3 % (801 cases) had mild non-proliferative retinopathy (NPDR), 7.1 % (77 cases) had moderate NPDR, 6.8 % (74 cases) had proliferative retinopathy, and 12.8 % (140 cases) had diabetic macular edema. Older patients had more chance of having poor quality pictures (p < 0.001 between patients older and younger than 70 years). When non-mydriatic fundus photography was compared with dilated fundus examination by an ophthalmologist, sensitivity of 99.3 %, specificity of 88.3 %, and positive predictive value of 85.3 % were found. Non-mydriatic digital retinal photography is an efficient method for DR screening. The test has high sensitivity and specificity. The test, as performed in community health centers in the south of the country, contributed to the early diagnosis of >1,000 cases of DR. Many patients can be followed up in a fast and efficient way, although the test cannot replace a complete eye examination after pupil dilation mainly in older people. Other non-DR sight-threatening ocular pathologies can be also detected.

PS11 - 2. Higher urinary sodium excretion is weakly associated with albuminuria, but not with retinopathy in type 1 diabetes: the EURODIAB Study

Nutritional advice that favourably affects cardiovascular risk factors, such as blood pressure (BP), may also have a favourable effect on microvascular complications. Restriction of salt intake is known to reduce BP. We studied the association of urinary sodium excretion, as a marker of salt intake, with the prevalence of microalbuminuria, macroalbuminuria, non-proliferative and proliferative retinopathy in individuals with type 1 diabetes (T1DM).

Proton Radiation Therapy for the Treatment of Pediatric Retinoblastoma

photocoagulation, and thermotherapy. Following plaque radiation therapy, there was a total of 33/255 recurrences (12.9%), with 26/33 recurrences occurring within the first year. The median time to recurrence was 4.5 months. Sixty-five patients (25.5%) underwent enucleation due to poor vision, pain or viable tumor, with 44/65 of the surgeries occurring within the first year and 18/65 within 5 years after plaque treatment. The median time to enucleation was 7 months. The actuarial local recurrence rates at 1 year, 5 year, and 10 year were 10.2%, 11.8%, and 12.2%, respectively, while actuarial rates for enucleation were 17.3%, 24.3% and 24.7%, respectively. Radiation-related complications included cataracts (n Z 64), non-proliferative retinopathy (n Z 46), maculopathy (n Z 26), retinal neovascularization (n Z 25), glaucoma (n Z 9), and vitreous hemorrhage (n Z 2). Conclusions: Plaque radiation therapy is effective for the management of retinoblastoma with 88% tumor control at 10 years. The choice of iodine125 provides deeper tumor penetration compared to other focal organpreserving therapies, yet limits full ocular and systemic exposure, resulting in beneficial local control. The majority of local failures occur within the first year after plaque brachytherapy. ICRB groups B and C are the bestsuited candidates (basal diameter less than 16 mm and thickness less than or equal to 9 mm). Author Disclosure: N.R. Patel: None. J. Emrich: None. N. Ghodasara: None. F. Troicki: None. L. Komarnicky-Kocher: None. C.L. Shields: None. S. Kaliki: None. A. Mashayekhi: None. S.E. Lally: None. J.A. Shields: None.

Medical and psychological outcomes for young adults with Type 1 diabetes: no improvement despite recent advances in diabetes care

To assess medical and psychological outcomes among young people with Type 1 diabetes and to compare medical outcomes with a previous audit. An observational study in two diabetes clinics for young adults (aged 16-21 years) in Sheffield, UK. Young people (n = 96: 81.4% response rate) with Type 1 diabetes (diagnosed > 6 months) completed measures of depressive symptoms, anxiety and disordered eating and consented for their medical records to be consulted. Mean HbA1c (86 ± 23 mmol/mol; 10.0 ± 2.1%); was comparable with that reported previously and considerably higher than recommended (< 58 mmol/mol or 7.5%). Screening rates were improved and non-attendance was lower than previously reported, but levels of non-proliferative retinopathy have increased. Microvascular complications are present in 46.9% of those diagnosed more than 7 years. Elevated levels of disordered eating were reported by 35.1%. Those scoring above cut-off levels for clinical anxiety (26.6%) and depression (10.9%) are comparable with other work with young people with Type 1 diabetes. Despite technological advances and improvements to delivery of care, HbA1c remain above recommended levels in a significant proportion of young people, many of whom already have microvascular complications. We need to learn from European centres who achieve better results, improve transition from paediatric care, integrate mental health support with diabetes care provision and take into account young people's views about clinic.

Diabetes mellitus en el anciano: Enfermedad heterogénea, de clasificación dinámica y tratamiento predecible.

In order to evaluate clinical presentation and to determinate classification criteria of type I diabetes (I-DM) in the elderly, we carried out a study in 258 patients more than 60 years old of which 40% used insulin by failure to oral hipoglycemic agents (OHA). The prevalence of ischemic cardiovascular disease was 36%, peripheralvascular disease 34% and stroke 30%; non-proliferative retinopathy 47%, peripheral neurophaty 37% and nephropathy 16%. Obesity (36%), hypertension (33%) and hypercholesterolemia (12%) were evaluated. The average duration of diabetes was 20 years. Postglucagon C-Peptide, HLA-DR antigens and islet cell antibodies (ICA), were measured in 75 older diabetic patients on treatment of which 24 used insulin, 40 OHA and 11 diet. Older patients on insulin had longer duration of disease, less obesity, low basal level of C-Peptide and a low response post glucagon; C-Peptide (0.94+0.5 pmol/ml) compared with patients on diet (1.8+0.9 pmol/ml) and OHA (1.8+0.8 pmol/ml). Older diabetics on insulin therapy had a greater frequency of HLA-DR3 (42%) and HLA-DR4 (21%). The ICA wasnegative in most patients. This study shows the high prevalence of macrovascular and microvascular disease in elderly patients with diabetes mellitus and that the most reliable parameter in classifying I-DM is the measurement of basal and postglucagonC-Peptide. HLA-DR specific markers can be used with this parameter because their expression is partly shared. This approach appears useful in the older diabetic patients to help classify diabetes and its management.

OP90 Non-Attendance at Diabetes Eye Screening and Risk of Sight-Threatening Diabetic Retinopathy: Population-based Cohort Study

BackgroundPopulation-based diabetes eye screening aims to reduce the occurrence of visual loss from diabetic eye disease. This study evaluated whether repeated non-attendance for diabetes eye screening is associated with risk...

Overexpression of Hemopexin in the Diabetic Eye

OBJECTIVEHemopexin is a well-recognized permeability factor in the kidney, but its potential role in blood-retinal barrier (BRB) breakdown has not been explored. The main aims of this study were as follows: 1) to determine hemopexin expression in the retina and its content in the vitreous fluid from diabetic patients with diabetic macular edema (DME) and nondiabetic patients, 2) to evaluate the effect of hemopexin on BRB permeability, and 3) to determine whether dexamethasone prevents an eventual hemopexin-induced hyperpermeability.RESEARCH DESIGN AND METHODSBiological material included 1) retinas from 10 diabetic donors with nonproliferative retinopathy and from 10 nondiabetic donors and 2) vitreous fluid from 14 patients with DME and 14 nondiabetic patients. Hemopexin and hemopexin receptor mRNA levels were measured by quantitative RT-PCR and hemopexin concentrations by ELISA. The effect of hemopexin on permeability in culture was evaluated in human retinal pigment epithelial (ARPE)-19 cells and bovine retinal endothelial cells. The experiments were repeated in the presence of hemopexin-neutralizing antibodies and dexamethasone.RESULTSA higher expression of hemopexin was detected in the retinal pigment epithelium (RPE) from diabetic patients in comparison with nondiabetic control subjects. Intravitreal hemopexin concentration was higher in patients with DME than in nondiabetic subjects. Hemopexin significantly increased permeability in ARPE-19 cells, which was prevented by both hemopexin-neutralizing antibodies and dexamethasone.CONCLUSIONSHemopexin is overexpressed in the RPE of diabetic patients with DME and induces the breakdown of RPE cells in vitro. Dexamethasone was able to prevent hemopexin-induced hyperpermeability. Our results suggest that hemopexin can be considered a new pathogenic candidate for DME.

Changes in Detection of Retinopathy in Type 2 Diabetes in the First 4 Years of a Population-Based Diabetic Eye Screening Program

OBJECTIVEAnnual diabetic eye screening has been implemented in England since 2008. This study aimed to estimate changes in the detection of retinopathy in the first 4 years of the program.RESEARCH DESIGN AND METHODSParticipants included 32,340 patients with type 2 diabetes resident in three London boroughs with one or more screening records between 2008 and 2011. Data for 87,570 digital images from 2008 to 2011 were analyzed. Frequency of sight-threatening diabetic retinopathy (STDR) was estimated by year of screen for first screens and for subsequent screens according to retinopathy status at first screen.RESULTSAmong 16,621 first-ever screens, the frequency of STDR was 7.1% in 2008, declining to 6.4% in 2011 (P = 0.087). The proportion with a duration of diabetes of <1 year at first screen increased from 18.7% in 2008 to 48.6% in 2011. Second or later screens were received by 26,308 participants. In participants with mild nonproliferative retinopathy at first screen, the proportion with STDR at second or later screen declined from 21.6% in 2008 to 8.4% in 2011 (annual change −2.2% [95% CI −3.3 to −1.0], P < 0.001). In participants with no retinopathy at first screen, STDR declined from 9.2% in 2008 to 3.2% in 2011 (annual change −1.8% [−2.0 to −1.7], P < 0.001). Declining trends were similar in sociodemographic subgroups.CONCLUSIONSAfter the inception of population-based diabetic eye screening, patients at lower risk of STDR contribute an increasing proportion to the eligible population, and the proportion detected with STDR at second or subsequent screening rounds declines rapidly.