Abstract
Purpose :
The American Academy of Ophthalmology (AAO) recommends annual monitoring of patients (pts) with mild or moderate nonproliferative diabetic retinopathy (NPDR) to prevent progression. The purpose of this study is to assess adherence to AAO guidelines over 5 years (y) among untreated mild/moderate NPDR pts.
Methods :
A retrospective cohort study was designed using MarketScan commercial and Medicare claims data. Adult pts newly diagnosed with mild or moderate NPDR between 7/1/2007-4/30/2012 were included (verified by 18-month pre-diagnosis period). Pts were followed for 5y and censored if they received treatment or progressed to vision-threatening DR (VTDR; defined as development of severe NPDR, proliferative DR, or DME). Adherence to AAO monitoring guidelines was defined as having any encounter with eye care professionals (ECP) for each year in which a patient was not censored. This included ECP office visits, retinal imaging (RI), or ophthalmoscopy. General ECP visits had to be at least 30 minutes to allow for sufficient time for a dilated eye exam. RI included fundus, optical coherence tomography (OCT), and angiography.
Results :
7603 pts (6269 mild and 1334 moderate NPDR) contributed 32,637 person-years (PY). More than two thirds of pts (n=5399, 71%) remained in the study through 5y (no diagnosis of progression to VTDR or treatment). The majority of these pts (n=7258, 96%) had ≥1 encounter with ECP in the first year of diagnosis, but this decreased to 61-68% in years 2-5. Of pts with an ECP encounter in year 1, 76% of their subsequent PY included an ECP encounter. RI was used in 42% of the observed PY with fundus photography (n=7931, 24%) being the most common followed by OCT (7241, 22%) and angiography (2104, 7%). Similar to encounters, these RIs were mostly used during year 1 (57% of mild and 67% of moderate) but decreased to 36-40% in years 2-5 for both cohorts.
Conclusions :
Newly diagnosed pts with DR tend to adhere to AAO DR monitoring guidelines in year 1, but this decreases significantly in subsequent years resulting in the potential for progression to VTDR to go unchecked. With the relatively low rates of RI, subclinical signs of diabetic eye disease (e.g. subtle cystic edema seen on OCT) may be missed. Given a prior analysis for this cohort demonstrated >45% of moderate pts progressed to VTDR over 5y, closer follow up with more frequent RI is merited.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.