Social deprivation as a risk factor for late presentation of proliferative diabetic retinopathy

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.

The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group, Report 1: baseline characteristics and visual acuity outcomes in eyes treated with intravitreal injections of ranibizumab for diabetic macular oedema

“…In particular for DMO, the haemoglobin A1c and blood pressure in pivotal trials can be substantially different from ‘real-world’ patients,9 10 although a recent study suggests this may not affect outcomes of treatment 11. Electronic medical record (EMR) systems, if well-designed, offer more complete, prospective, real-time data collection as a by-product of routine care.…”

Causes and Clinical Impact of Loss to Follow-Up in Patients with Proliferative Diabetic Retinopathy

“…However, Negretti et al [32] stressed that the national guidelines for scheduled follow-up remain important due to the occasional patient who is at a very high risk of vision loss and the implications that the proper timely assessment has on patients' medical and ocular condition. It was also stressed that this group of patients is more often socially deprived, with an increased likelihood of other medical conditions, and they often have a very poor attendance history [33]. Our findings revealed significant positive correlations between lack of social support and presence of other disabling comorbidities and lack of social support and age, further stressing the vulnerability of these patients to LTFU.…”

Does delay in referral of proliferative diabetic retinopathy from the diabetic eye screening programme lead to visual loss?

“…This group of patients are more often socially deprived, with an increased likelihood of other medical conditions, and they often have a very poor attendance history. 5 Screening photographs cannot be used to predict hospital eye service attendance record, underlying medical conditions, or response to treatments. Therefore, we believe that prompt referral remains very important.…”