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Thomas L Berenberg, Anton Orlin, Donald J D'Amico, Szilard Kiss; Extent of Retinopathy and Treatment of Diabetic Patients Referred for Ophthalmic Evaluation: 8 Year Experience at a Tertiary Referral Center. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2283. doi: https://doi.org/.
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Diabetic retinopathy (DR) remains a leading cause of visual impairment among working-aged individuals. Diabetic eye disease, when diagnosed at an early stage and managed appropriately, is a preventable cause of blindness. However, there is limited data on the extent of DR among patients presenting for initial eye exam to a retina specialist. The current analysis examines the level of DR and types of intervention in a large, consecutive cohort of diabetic patients referred for ophthalmic evaluation to an academic center.
This retrospective, non-interventional, single-center, chart review included all diabetic patients seen by three retina specialists at Weill Cornell Medical College from November 2005 until October 2013. Patients were included for analysis based on ICD-9 diagnosis code 250.xx; patients were further classified using ICD codes for the level of retinopathy (362.01-.07, -.53, -.83) and appropriate CPT codes for intervention (67028, 67036, 67040, 67041, 67107, 67108, 67113, 67210, 67228).
Over the 8-year course, 2044 patients with a diagnosis of diabetes presented for eye exams. 745 (36.4%) had no DR; 1299 (63.6%) had DR. Of those with DR, 923 (71.1%) had non-proliferative DR (NPDR), while 376 (28.9%) had proliferative DR (PDR). Of all patients, 288 had diabetic macular edema (DME) (14.1% of total). Of patients with PDR, 91 (24.2%) also had DME, while 197 patients with NPDR had DME (21.3%). 184 patients (9.0% of total patients) had at least one intravitreal injection (IVI) during the course of 8 years, (range of 1-15 injections per patient, mean of 2.8 injections). 65 patients (3.2% of total patients) had at least one focal laser treatment (range 1-4, mean 1.6). 100 patients (4.9% of total patients) underwent pan-retinal photocoagulation (PRP) (range 1-7, mean 1.9). 133 patients (6.5% of total patients) had pars plana vitrectomy (PPV) (range 1-8, mean 1.8).
In the current review, the majority (63.6%) of patients with diabetes presenting for an eye exam had some level of DR. Moreover, nearly a third of patients with DR had PDR and a fifth had DME. The most common intervention during these 8 years was IVI, followed by PPV. Despite an increasing awareness of complications of diabetes, the current study indicates that a significant portion of patients continue to present with sight-threatening complications of DR.
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