Analysis of patient population presenting with proliferative diabetic retinopathy identified and referred from Irish National Screening Program, RetinaScreen

Abstract

Purpose : Due to the risk of severe vision loss associated with proliferative diabetic retinopathy (PDR), the RetinaScreen program has pathways designed for urgent PDR referrals. In this retrospective analysis, we report on the population and treatment needs of previously PRP-treated (R3P1) and PRP-naive (R3P0) (PDR) patients screened and referred for treatment to the Mater Hospital Diabetic Retina Treatment (DRT).

Methods : From January 2016 to December 2017, 196,003 patients were screened under the National Diabetic Retinal Screening Program. Medical records of all patients referred with PDR to the Mater Hospital DRT were analyzed. Data was collected regarding retinopathy grade, photocoagulation procedures, anti-VEGF injections, OCT central subfield thickness (CST), best-measured visual acuity and history of previous ocular treatments. Snellen visual acuity was converted to LogMAR visual acuity scale for statistical analysis.

Results : During the study period, 4,515 referrals were made to the Mater DRT from RetinaScreen. Excluding non-diabetic screening findings, 2,935 patients were referred with diabetic retinopathy. 242 patients (409 eyes) had PDR (173 binocular, 63 monocular), 245 eyes (59.9%) were graded R3P1 and 164 eyes (40.1%) were graded R3P0.

From the 245 eyes R3P1 cohort, 100 eyes (R3sM0P1) were graded with stable PDR and of the remaining 145 R3aP1 eyes, 110 eyes (75.9%) were given additional PRP (R3aM0P1), 3 eyes (2%) were treated with anti-VEGF injections and PRP (R3aM1P1) and 32 eyes (22.1%) were treated with anti-VEGF alone (R3sM1P1).

From the 164 PRP-naïve eyes (R3P0), 146 eyes (89%) (R3aM0P0) were treated with PRP, 14 eyes (8.5%) (R3aM1P0) were treated with PRP and anti-VEGF injections and 4 eyes (2.4%) (R3aM1P0) were managed with anti-VEGF alone.
14 eyes (8.5%) of the R3aP0 group were managed with a combination of PRP, focal laser and anti-VEGF injections.

Conclusions : RetinaScreen has been very successful at identifying proliferative disease. In the current format, both treatment-naïve and previously treated eyes are referred promptly. The use of anti-VEGF agents is becoming more frequent in the management of proliferative disease. A significant number of treated eyes required further laser, indicating the prevalence of undertreated PDR in Ireland prior to RetinaScreen.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.