June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Prevalence and 5-year Incidence and Progression of Diabetic Retinopathy from a National Telemedicine Screening Program - the Singapore Integrated Diabetic Retinopathy Programme
Author Affiliations & Notes
  • Gavin S Tan
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
    Duke-NUS Graduate Medical School, Singapore, Singapore
  • Alfred Tau Liang Gan
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  • Charumathi Sabanayagam
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
    Duke-NUS Graduate Medical School, Singapore, Singapore
  • Haslina Binte Hamzah
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  • Ecosse Luc Lamoureux
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
    Duke-NUS Graduate Medical School, Singapore, Singapore
  • Ngiap Chuan Tan
    Singhealth Polyclinics, Singapore, Singapore
    Duke-NUS Graduate Medical School, Singapore, Singapore
  • Tien Yin Wong
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
    Duke-NUS Graduate Medical School, Singapore, Singapore
  • Footnotes
    Commercial Relationships   Gavin Tan, None; Alfred Gan, None; Charumathi Sabanayagam, None; Haslina Hamzah, None; Ecosse Lamoureux, None; Ngiap Chuan Tan, None; Tien Wong, None
  • Footnotes
    Support  Khoo Mentored Research Award (Duke-NUS-KMRA/2015/0002)
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2884. doi:
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      Gavin S Tan, Alfred Tau Liang Gan, Charumathi Sabanayagam, Haslina Binte Hamzah, Ecosse Luc Lamoureux, Ngiap Chuan Tan, Tien Yin Wong; Prevalence and 5-year Incidence and Progression of Diabetic Retinopathy from a National Telemedicine Screening Program - the Singapore Integrated Diabetic Retinopathy Programme. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2884.

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

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Abstract

Purpose : To describe the prevalence of diabetic retinopathy (DR) and the 5-year incidence and progression of DR among persons with diabetes mellitus participating in a national telemedicine screening program.

Methods : The Singapore Integrated DR Program (SiDRP) was gradually implemented from 2010 to 2015, covering 18 primary care clinics across Singapore. From 2010 to 2014, a total of 22,470 patients had a screening examination with 44,141 readable fundus photographs. 10,141 patients (45.1%) had at least 1 further screening event within the study period and were included in the analysis of incidence and progression. Participants underwent two field 45° non-stereoscopic retinal digital photographs per eye, which were graded according to an adapted International Clinical Diabetic Retinopathy Scale. Referable DR (RDR) was defined as moderate nonproliferative DR (NPDR), severe NPDR, or proliferative DR, with or without maculopathy; or mild NPDR with maculopathy.

Results : At baseline, the prevalence of any DR, diabetic macular edema (DME) and RDR was 15.8%, 3.7% and 6.7% respectively. Annual incidence of any DR in patients without retinopathy at baseline was 2.30% (95% confidence interval [CI], 2.06 to 2.57) in the first year of follow-up, rising to 5.01% (95% CI, 3.53-7.04) in the fifth year. Over 1 year, progression to RDR was 0.67% (95% CI, 0.55 to 0.83) in those with no DR at baseline, but was significantly higher among those with mild NPDR at baseline (8.47%, 95% CI, 7.15-10.01). In multivariate models adjusting for age, gender and HbA1c, both any DR and RDR at baseline were associated with higher known duration of diabetes, HbA1c, systolic blood pressure (sBP), and serum creatinine; and lower body mass index (BMI). Incidence of RDR was associated with older age at diagnosis, higher sBP, known duration of diabetes and HbA1c; while progression of mild NPDR to RDR was associated with lower BMI, higher HbA1c and male gender in multivariate models.

Conclusions : This study provides the first large-scale baseline prevalence and incidence data in population-based cohorts of patients with diabetes attending diabetic retinopathy screening in Singapore. Persons with mild NPDR had a much higher incidence of progression to RDR. Metabolic risk factors such as glycated hemoglobin were associated with incidence of and progression to RDR.

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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