Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study

Sharif, Ali; Jendle, Johan; Hellgren, Karl-Johan

doi:10.1007/s13300-020-00957-0

Cited by 11 publications

(24 citation statements)

References 31 publications

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“…24 Because of its high specificity, remote fundus photography is a particularly attractive method to reduce the cost of screening patients who are expected to have low rates of DR such as those who have completed a recent healthy eye examination. Even with extended intervals between inperson appointments, such lower-risk patients have been shown to be adherent to subsequent screening visits, with infrequent progression to DR. [54][55][56] The projected cost-savings yielded by our teleophthalmology program in our not-for-profit, integrated suburban health system is similar to projections made by other studies that have analyzed remote diabetic retinal screening programs in largely underserved populations. One such study found a cost-savings of 23.3% for diabetic eye screening conducted by automated widefield nFP provided in the primary care setting as compared with standard dilated retinal examinations.…”

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Kuo¹,

Anjum²,

Nguyen³

et al. 2021

OPTH

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Purpose We conducted a cross-sectional study to assess the utilization of a tele-ophthalmology screening program in a low-risk, suburban population of patients with diabetes. Methods A total of 214 diabetic patients without previously documented diabetic retinopathy (DR) underwent point-of-care non-mydriatic fundus photography through their primary care providers at five Beth Israel Lahey Health locations. The characteristics of the patients who received remote screening were compared with those patients who were eligible for screening but did not take part in the program. Time-driven activity-based costing (TDABC) was implemented to examine the cost of screening by tele-ophthalmology compared with in-person examinations. Results Tele-ophthalmology screening was more likely to be provided for patients who were younger (OR 0.985; 95% CI 0.973–0.997, p =0.016), who were obese (OR 2.04; 95% CI: 1.47–2.84, p =0.008), who had an HbA1c above 8.0% (OR 1.60; 95% CI: 1.13–2.26, p =0.031), or who had an eye examination in the past year (OR 5.55; 95% CI: 3.89–7.92, p <0.001). Those patients newly diagnosed with DR because of the program were more likely to have diabetic nephropathy (OR 7.79; 95% CI: 1.73–35.05, p =0.007). TDABC identified a health system cost-savings of between $8 and $29 per patient screened by tele-ophthalmology compared with the cost of in-person eye examinations. Conclusion Tele-ophthalmology presents an opportunity to reduce the costs of screening patients without prior evidence of DR, especially those who have completed a comprehensive eye examination within the prior year.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Kuo¹,

Anjum²,

Nguyen³

et al. 2021

OPTH

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“…Our data suggest that for our study population, screening intervals for individuals with T1DM with no retinopathy at baseline and no risk factors (no retinopathy/ maculopathy, HbA1c <65 mmol, duration of disease <6 years) can be safely extended to at least 3 years, whilst those living with T2DM with no risk factors (no retinopathy/maculopathy, HbA1c <65 mmol, duration of disease <6 years, age above 65 at diagnosis, not requiring insulin) can be safely extended to beyond 5 years. Whilst there is a risk that adopting such a long duration between screening assessments may affect rescreen attendance, a recent Swedish study found that extending treatment intervals to 36 months was not only safe but did not adversely affect attendance rates 43 . Whilst further work is required to validate this finding, our data also support a rescreen interval of up to 3 years in low-risk patients.…”

Section: Discussionsupporting

confidence: 68%

Risk Factors for Progression to Referable Diabetic Eye Disease in People With Diabetes Mellitus in Auckland, New Zealand: A 12-Year Retrospective Cohort Analysis

Hill

Mullins

Murphy

et al. 2021

Asia-Pacific Journal of Ophthalmology

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Purpose: To evaluate the prevalence and risk factors for the development of any and referable diabetic eye disease in a multi-ethnic New Zealand population with diabetes mellitus attending a regional retinal screening service. Methods: Retrospective observational cohort study of people living with diabetes who attended the Auckland Regional Diabetic Retinal Screening Programme 2006–2018 inclusive (n = 41,786). Results: Any retinopathy/maculopathy was present at first screening for 48.2% [95% confidence interval (CI): 45.8%–50.6%] / 37.8% (95% CI: 35.5%– 40.1%) of people with Type 1 and 25% (95% CI: 24.6%–25.4%) / 21.9% (95% CI: 21.5%–22.3%) with Type 2 diabetes. Referable retinopathy at baseline screening was 4.4% (95% CI: 3.6%–5.3%) and 1.6% (95% CI: 1.5%–1.7%) among people with Type 1 and Type 2 diabetes mellitus, respectively. After 4 years, cumulative incidence for referable retinopathy /referable maculopathy was 12/36 per 1000 people with Type 1 and 2.4/16 per 1000 people with Type 2 diabetes. Independent hazards for disease progression varied for the diabetes cohort types but baseline grade, duration of diabetes, and HbA1c were common to all. Conclusions: Referable diabetic eye disease at the first screening and after 4 years of follow-up is uncommon. Lengthening of the screening intervals for people with no or mild diabetic eye disease at first screening assessment could be considered.

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“…Those with DR were less likely to attend all follow‐up visits, but participants may have attended DR screening elsewhere as part of usual care. A recent publication found those at increased risk of DR progression undergoing 18‐month screening had greater adherence to screening than those with a 36‐month interval, but adherence rates were > 90% in both groups 29 . Nevertheless, a history of non‐adherence should not influence screening intervals 28 …”

Section: Discussionmentioning

confidence: 99%

“…A recent publication found those at increased risk of DR progression undergoing 18-month screening had greater adherence to screening than those with a 36-month interval, but adherence rates were > 90% in both groups. 29 Nevertheless, a history of non-adherence should not influence screening intervals. 28 More frequent DR screening can be tailored to individual risk factors.…”

Section: Variables At Baselinementioning

confidence: 99%

Retinopathy prevalence, incidence and trajectories in type 2 diabetes: The Fremantle diabetes study phase II

et al. 2022

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Aims To determine diabetic retinopathy (DR) prevalence, incidence, and whether distinct trajectories are associated with DR‐complicating Type 2 diabetes. Methods Retinal photographs from Fremantle Diabetes Study Phase II (FDS2) participants with Type 2 diabetes recruited in 2008–2011 and who attended biennial assessments for up to 6 years were graded as no DR, mild non‐proliferative DR (NPDR), moderate NPDR or severe NPDR/proliferative DR. Baseline DR prevalence, and the cumulative incidence of moderate NPDR or worse in those without DR at baseline, were calculated. Group‐based DR trajectory modelling was performed. Logistic regression determined independent associates of incident moderate NPDR or worse and trajectory group membership. Results Of 1521 participants (mean age 65.6 years, 52.1% males, median diabetes duration 9.0 years; 98% of all FDS2 participants with Type 2 diabetes) with gradable baseline photographs, 563 (37.0%) had DR. During a median 6.1 years of follow‐up, 23 (3.2%) without baseline DR developed at least moderate NPDR (crude incidence 6.1/1000 person‐years) with HbA1c the sole independent predictor (odds ratio [95% CI]: 1.62 [1.30–2.02] per 1% [11 mmol/mol] increase). Trajectory analysis showed two distinct groups, those with baseline/persistent DR (20%) and those remaining DR free (80%). Longer diabetes duration, insulin use, higher mean HbA1c, higher mean systolic blood pressure and higher mean urinary albumin: creatinine ratio all increased the odds (p ≤ 0.014) of being in the persistent DR trajectory group. Conclusions The low incidence of at least moderate NPDR reflects the trajectory analysis. The currently recommended biennial retinal screening frequency for individuals without DR could potentially be extended.

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Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study

Cited by 11 publications

References 31 publications

Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Risk Factors for Progression to Referable Diabetic Eye Disease in People With Diabetes Mellitus in Auckland, New Zealand: A 12-Year Retrospective Cohort Analysis

Retinopathy prevalence, incidence and trajectories in type 2 diabetes: The Fremantle diabetes study phase II

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