Abstract
Purpose:
To assess if a delay was present in referral for patients with diabetic retinopathy in rural settings by evaluating the retinopathy status and level of intervention at the first presentation to a retina service. To further evaluate the causes of delay to help formulate measures for timely referral preventing disease progression.
Methods:
A retrospective consecutive case analysis was performed at Aspirus Grand View Eye Center. Aspirus Wausau Hospital’s Institutional Review Research Board approved this study (#14.12.409E). Patients with diabetic retinopathy referred for evaluation were included in the study. The retinopathy and the treatment required were assessed for the initial visit. Eyes with visual acuity (VA) of 20/200 or less were identified and the cause of reduced vision assessed; those not related to diabetes were excluded. A delay was defined as poor vision associated with (1) tractional retinal detachment secondary to proliferative diabetic retinopathy; & (2) rubeosis with vitreous hemorrhage obscuring retinal view and no past history of PRP laser. A probable delay was defined as poor vision associated with clinically significant macular edema (more than 1 year) and/or presence of macular ischemia/large exudates over fovea.
Results:
Thirty three consecutive patients with 66 eyes were evaluated. 9 patients (18 eyes) with Type 1 diabetes (diagnosed before age of 30) and 24 patients (46 eyes) with Type 2 diabetes were included. 7 out of 66 eyes (11%) presented with VA at or less than 20/200. The cause of decreased vision included tractional retinal detachment in 2 eyes (3%); CSME in 3 eyes (5%) (2 improved with treatment, 1 remained poor below 20/200 despite treatment after 1 year); vitreous hemorrhage and no past PRP but no rubeosis in 1 eye (2%) (gained good VA after vitrectomy); and hemorrhagic PVD in 1 eye (2%). Hence 2 eyes (3%) had definitive preventable delay with advanced PDR requiring advanced retinal surgery. The reason for delay was loss of insurance secondary to unemployment. 1 eye (2%) was classified as probable delay with long standing CSME and macular ischemia; reason for delay was identified as uncontrolled diabetes and lack of prompt retinal care.
Conclusions:
A sizable number of patients in rural settings present with advanced retinopathy, which is essentially preventable with earlier treatment. The delay leads to poor long-term visual prognosis.