Diabetic Eye Disease of American Indians/Alaska Natives, 2016-2019, as Found with Ultra-Wide-Field Imaging

Abstract

Purpose : Recently the Indian Health Service-Joslin Vision Network (IHS-JVN) teleophthalmology program has transitioned to macula-centered, 200^o field-of-view (FOV), ultra-wide-field imaging (UWFI) from multi-field, nonmydriatic, 45^o FOV fundus photography (NMFP). This project analyzed the prevalence rates of diabetic retinopathy (DR) and macula edema (DME) from UWFI and compared these rates to those previously reported when NMFP was the predominant technology.

Methods : The sample was composed of American Indian and Alaskan Natives (AI/AN) with diabetes served by the nationally-distributed (n=100 clinics) and clinically validated IHS-JVN from 01Nov2016 to 31Oct2019 (n=53,000). Patients were recruited during primary care visits. All patients were imaged using UWFI. Patients’ first available imaging study over the time period was included in this analysis. All images were evaluated by a certified optometrist or ophthalmologist using validated protocols to identify the severity levels of non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), and DME. The analysis included sight-threatening retinopathy (STR), defined as presence of severe NPDR, any PDR, or any DME.

Results : Gradable images were achieved in 95% of patients. Prevalence of any NPDR, PDR, any DME, and STR was 28.6%, 2.8%, 3.0% and 5.3%, respectively. These rates of any DR and STR are higher than those from a recent previous report predominantly based on NMFP (DR=17.7% and STR=4.2%); however, the present rates are consistent with a subset analysis of UWFI images in the recent previous report (DR=28.2% and STR=5.4%). The higher rate of any DR from UWFI was associated with the clinicians’ ability to more easily identify lesions found in mild and moderate DR; e.g., in the present analysis, 22.3% of diagnosed mild NPDR had findings outside standard ETDRS fields. Notably, findings peripheral to ETDRS were noted for 2.2% of patients for whom DR was still clinically considered ‘absent’.

Conclusions : Replacement of NMFP with UWFI in the IHS-JVN has led to higher gradable rates and more complete prevalence data on diabetic eye disease in AI/AN. The present analysis in this high-risk population indicates prevalence is higher than found by NMFP alone.

This is a 2020 ARVO Annual Meeting abstract.