Patients with diabetes seldom need treatment 2 years after uneventful retinal screening
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Patients with minimal or no retinopathy are unlikely to require retinal treatment for diabetic retinopathy within 2 years of screening, according to a study published in JAMA Ophthalmology.
The retrospective cohort study evaluated patients who were initially screened in 2012, had photographs indicating minimal or no retinopathy and then had at least 2 years of follow-up.
“The medical records for patients with minimal or no retinopathy were cross-referenced with Current Procedural Terminology codes used for intravitreal injections, retinal lasers and pars plana vitrectomy,” Bobeck S. Modjtahedi, MD, Kaiser Permanente Baldwin Park Medical Center, California, and colleagues wrote. “We identified patients then had their medical records manually reviewed; the clinical indication and type of interventions were subsequently categorized.”
A total of 116,134 patients had diabetic retinopathy screening photographs taken, 81,544 had no retinopathy, and 11,689 had minimal retinopathy. Of those, 85.4% of patients without retinopathy and 83.9% of patients with minimal retinopathy had 2 years of follow-up evaluations by clinicians.
According to the study, 11 patients without baseline retinopathy required treatment for complications of diabetic retinopathy, and 44 patients required intervention because of nonrelated conditions.
Results showed that the most common intervention for treatment of diabetic retinopathy was panretinal photocoagulation for proliferative diabetic retinopathy in patients with minimal and patients without baseline retinopathy. Pars plana vitrectomy was the most common intervention in the study not related to diabetic eye disease, as 42 patients without baseline retinopathy and three patients with minimal retinopathy underwent this procedure.
“Most interventions were rendered for conditions not directly related to diabetic retinopathy,” the authors wrote. “Additional study is required to determine the ideal screening intervals for patients with diabetes as well as the economic, clinical and practical value to ultra-widefield imaging.” – by Erin T. Welsh
Disclosure: Modjtahedi reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
Perspective
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Mark Swanson, OD, FAAO
When we grade diabetic retinopathy by any method, be it clinical examination, in-office fundus photography or by widefield telemedicine technology, we are assessing the risk of developing vision-threatening retinopathy. Multiple studies show for those with no or minimal retinopathy the risk is low, regardless of screening method.
The idea that screening can occur every 2 years is not new. Agardh and colleagues had looked at the same 2-year to 3-year interval in type 2 diabetes with fundus photographic screening in 2011. The American Geriatrics Society currently recommends 2-year screening for low-risk older adults with diabetes.
Perhaps the most interesting aspect of this study was the number of individuals who actually did have treatment for neovascularization. This could have been due to misgrading or misreporting, but it would be interesting to know the clinical histories. It’s possible this may have been the result of rapid blood sugar control rather than loss of blood sugar control. There are numerous cases in the literature where highly elevated blood sugars that are rapidly dropped produce a paradoxical neovascular retinopathy.
Reference:
Agardh E, et al. Diabetes Care. 2011;doi:10.2337/dc10-2308.
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