June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Optical Coherence Tomography (OCT) Screening at Diabetes Visits Increases Retina Referral for Patients with Diabetic Macular Edema (DME)
Author Affiliations & Notes
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Ruth Weinstock
    Clinical Research Unit and Joslin Diabetes Center, SUNY Upstate Medical University, Syracuse, New York, United States
  • Mark Warren
    Physicians East, Greenville, North Carolina, United States
  • Marcel Twahirwa
    Joslin Diabetes Center Affiliate, Doctors Hospital at Renaissance, Edinburg, Texas, United States
  • Joshua I Barzilay
    Kaiser Permanente of Georgia, Duluth, Georgia, United States
  • Madhu K Mohan
    Doctors Community Hospital, Lanham, Maryland, United States
  • Traci E Clemons
    EMMES, Rockville, Maryland, United States
  • Footnotes
    Commercial Relationships   Jennifer Sun, Genentech (F), Optovue (F); Ruth Weinstock, None; Mark Warren, None; Marcel Twahirwa, None; Joshua Barzilay, None; Madhu Mohan, None; Traci Clemons, None
  • Footnotes
    Support  Juvenile Diabetes Research Foundation International 17-2012-371, Genentech, Optovue
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2028. doi:
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      Jennifer K Sun, Ruth Weinstock, Mark Warren, Marcel Twahirwa, Joshua I Barzilay, Madhu K Mohan, Traci E Clemons; Optical Coherence Tomography (OCT) Screening at Diabetes Visits Increases Retina Referral for Patients with Diabetic Macular Edema (DME). Invest. Ophthalmol. Vis. Sci. 2017;58(8):2028.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine whether nonmydriatic OCT retinal imaging and an OCT-guided referral algorithm during diabetes (DM) care visits improves identification and referral of patients with DME.

Methods : This interventional study enrolled adults with type 1 or 2 DM from 9 primary DM clinics with DM duration ≥10 yrs or recent A1c ≥10%. OCT imaging led to an automated report detailing need for retina referral based on retinal thickness and image quality. Ocular therapy data was collected from retina specialists who saw referred patients and by phone calls at 3, 6 and 9 mo. Chart review at the same sites assessed historical rates of retina care for patients with matching eligibility criteria during the prior 6 mo.

Results : The cohort of 385 subjects had mean ± SD age 55±14 yrs, diabetes duration 19±11 yrs, and HbA1c 9.1±1.9%, with 50% female, 65% Caucasian, and 36% type 1 DM. Only 76% reported a prior eye examination (67% within 1 yr, 18% at 1-2 yrs and 14% >2 yrs). Of these, 62% were dilated, 11% undilated and 27% did not recall dilation status. Over 99% of participants were imaged in at least one eye, and 98% in both eyes. The OCT-based algorithm referred 11.5% of subjects and 7.8% of eyes based on central-involved retinal edema (64%), thickening threatening the center (25%) or low OCT signal (11%) suggestive of possible ocular pathology. In a multivariable model controlling for A1c, longer DM duration was related to greater referral likelihood. Only 23% of referred patients had prior retinal care. Of the 77% who followed up with a retina provider, 41% had vision threatening diabetic retinopathy (DR) and 53% underwent or planned therapy within the next 9 mo. Review of 564 charts from recent visits prior to this study found documentation of retina care in 6%.

Conclusions : These data suggest that targeted OCT screening is feasible within the non-ophthalmic, primary diabetes care setting and may identify pathology warranting referral in nearly 12% of patients. Nearly 80% of patients had not previously received retina care, and yet 41% had confirmed vision threatening DR and >50% needed treatment within 9 mo. By allowing effective detection of diabetic eye disease and enabling access to specialty care, OCT screening may potentially improve future visual outcomes in patients with diabetes.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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