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Emily Fletcher, Clareece R Kerby, Irene Mary Stratton, Sobha Sivaprasad, Clare Bailey, Elvira Massó-González, Sonia Maruti, Michael Ehrlich, Victor Chong, Peter Henry Scanlon; Incidence and prevalence of moderate to severe non-proliferative diabetic retinopathy within an English Screening Programme. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3830.
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© ARVO (1962-2015); The Authors (2016-present)
A retrospective observational study of people with diabetes (PWD) was carried out in an English screening programme (ESP) to describe the incidence and prevalence of moderate, moderately severe and severe non-proliferative diabetic retinopathy (NPDR) as there is a paucity of data in this area. They are classified into Early Treatment Diabetic Retinopathy Study (ETDRS) levels 43, 47 and 53 respectively based on the severity of multiple deep haemorrhages, the presence of venous beading (VB), and the severity of intraretinal microvascular abnormalities (IRMA).
The cohort was PWD aged 18 years and above on an ESP register between 1st January 2012 and 31st December 2016. Data was extracted from this register and from hospital eye service electronic patient records.Incident cases were new moderate to severe NPDR or worse in at least one eye each year, with a previous record of mild NPDR (level 20-35) or no DR (level 10). Prevalence of moderate to severe NPDR defined as the worst grade recorded each year in either eye was calculated each year, overall and by ETDRS level. The denominator was number of people registered on the screening database during that year. Lesions were reported by ETDRS level.
There were 43,236 subjects on the ESP register at any time during the 5 years. Incidence of moderate to severe NPDR or worse decreased from 6.3 (95% confidence interval (CI): 5.4, 7.5) per 1,000 PWD in 2013 to 5.0 (95% CI: 4.2, 5.9) in 2016 (p=0.015). Prevalence of moderate to severe NPDR decreased from 32.4 (95% CI: 30.4, 34.5) per 1,000 PWD in 2012 to 24.5 (95% CI: 22.9, 26.2) in 2016 (p<0.001).During 2016, prevalence of (ETDRS) levels 43, 47 and 53 and referrals from screening were 13.8 (95% CI: 12.6, 15.1), 2.3 (95% CI: 1.8, 2.9), 5.5 (95% CI: 4.8, 6.4) and 2.8 (95% CI: 2.3, 3.5) per 1,000 PWD respectively.Of 1,911 eyes at level 43, 95% had moderate IRMA. Of 290 eyes at level 47, 50% had VB and moderate IRMA. Of 643 eyes at level 53, 50% had severe IRMA.
Although there is a decrease in incidence and prevalence of moderate to severe NPDR, it is still a major public health problem in England warranting screening. This decrease may be related to improved glycaemic control, improved BP, increased DR screening uptake, regularly monitoring DR, increased longevity of PWD at low risk of DR or earlier detection of diabetes.
This is a 2020 ARVO Annual Meeting abstract.
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