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Paolo S. Silva, Jennifer K. Sun, Jerry D. Cavallerano, Lloyd P. Aiello; Diabetic Retinopathy and Preservation of Vision Among Joslin Diabetes Center Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4418.
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To evaluate vision and diabetic retinopathy (DR) outcomes among a diabetic population receiving eye and medical care over a 4-year period at an academic tertiary care multispecialty diabetes center.
Comprehensive retrospective review of the customized electronic medical record (EMR) of all patients evaluated at the Beetham Eye Institute and the Endocrinology Service of the Joslin Diabetes Center from 1/1/06-12/31/09. Structured search queries retrieved EMR demographic and medical history data which were recorded in a standardized database. Certified examiners measured ETDRS visual acuity (VA) and retina specialists recorded ETDRS clinical DR severity. ICD9 and CPT codes for laser and surgical procedures were retrieved from electronic billing records.
The 13,746 patients with diabetes mellitus (DM) had a median age of 57yrs (Q1,Q3: 46,69), DM duration 19yrs (9,26), and average HbA1c of 7.9% (6.8,8.6); 82% were white, 48% female, and 60% had type 2 DM. Of the 13,041 patients (95%) with documented DR severity, DR was present in 61% (7,933), proliferative DR in 17% (2,318), diabetic macular edema (DME) in 22% (2,850) and clinically significant DME (CSME) in 6% (763). Over 97% (1,110) of patients who progressed to PDR during the study period received panretinal laser photocoagulation and among patients who developed or had recurrent CSME (1,276), 99% received focal laser treatment or intravitreal injections. Of the 13,631 patients (99%) with documented VA, the median VA in the better-seeing eye was 20/20 (20/16,20/20) at baseline and was unchanged over the 4 yr study period. VA was > 20/20 in 79% (10,897), >20/40 in 94% (12,980) and 20/20 was associated with younger age (p<0.0001), shorter DM duration (p<0.0001), lower HbA1c (p=0.04), type 1 DM (p<0.0001), absence of systemic co-morbidities (p<0.0001), and absence of PDR or CSME (p<0.0001). Patients from minority groups had a nearly 2-fold increased risk for VA of 20/200 or worse (P=0.03). The diagnosis of PDR but not CSME was associated with VA <20/200 (p<0.0001).
In this large cohort of patients with DM receiving comprehensive multidisciplinary evidence-based diabetes and eye care, visual outcomes were excellent. These data suggest that intensive patient care can result in the preservation of normal or near normal vision in the vast majority of patients with DM, and that moderate or severe vision loss is rare.
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