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Josh Sia, Alfred Gan, Eva Fenwick, Preeti Gupta, Ecosse Luc Lamoureux, Ryan Man; Developing an Initial Risk Prediction Model for Non-Adherence to Recommended Post-Screening Ophthalmic Management in Patients with Type 2 Diabetes(T2DM). Invest. Ophthalmol. Vis. Sci. 2020;61(7):826.
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© ARVO (1962-2015); The Authors (2016-present)
While early detection and treatment of eye diseases in individuals with diabetes are critical in reducing the rates of diabetes-related vision loss, non-adherence rates to recommended post-ophthalmic screening referrals(POSR) can be suboptimal in Western countries. However, there is a paucity of such data, together with associated risk factors, in T2DM Asian patients. We determined the rates and risk factors of non-adherence to POSR and developed an initial risk prediction model in T2DM patients attending a national diabetes eye screening program in Singapore.
Data from 2,387 patients with T2DM (mean [SD] age: 66.5  years; 52.5% female) who underwent tele-ophthalmic screening between 2010 and 2014 and subsequently referred for tertiary ophthalmic management at the Singapore National Eye Centre (SNEC),were retrospectively extracted from electronic medical records (EMR).Criteria for referral included fundus signs of ocular pathology, unexplained vision loss or other ocular complaints. Non-adherence to POSR was defined as not attending the SNEC appointment within 6 months of the appointment date. A conditional inference tree (CIT) model, together with 14 clinical and socio-demographic factors were used to construct the risk prediction model, with discriminative accuracy assessed using the area under the receiving operating characteristic curve.
Non-adherence rate to POSR was 304(12.7%). The CIT model found that only participants’ ocular characteristics significantly predicted non-adherence, particularly individuals without any visible diseases in fundus images, and those with mild diabetic retinopathy only (P<0.05). The AUC for this model was 84% (95% confidence interval: 81%-86%), with non-adherence probabilities of the above two groups predicted at 55.2%(no visible disease) and 33.9%(mild DR).
The rate of non-adherence to POSR in Asian individuals with T2DM is low, with better ocular health being strongly predictive of non-adherence in our Asian population. Strategies focusing on those with none or mild DR, with no visible retinal signs, are recommended to reduce non-adherence rates and potentially reduce the risk of future vision loss in T2DM individuals.
This is a 2020 ARVO Annual Meeting abstract.
Predictor variables arranged in order of largest significant difference in an asymptotic test statistic comparing non-adherence between the split groups.
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