Purchase this article with an account.
Anjali Om, Timothy Arleo, Sarah DeVaro, Omar Ali, Yousuf Khalifa; Effect of Glycemic Control on Visual Acuity in a Teleretinal Screening Program. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3824.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Although ophthalmic sequelae of diabetes are well documented, the association between glycemic control and visual acuity may not be as linear. Previous studies have suggested that maintaining a HbA1c <7% preserves visual acuity and controlling glycemic index may prevent progression of diabetic retinopathy. We performed a retrospective cohort analysis in order to determine how glycemic control in patients identified with proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME) through a teleretina screening program affected progression of visual acuity at subsequent follow-up appointments.
Our cohort consisted of patients in the Grady Healthcare System screened via one of 13 diabetic teleretina screening cameras in the Atlanta area from January-September 2018. All pathological results were referred to the Grady Eye Clinic (GEC) for further evaluation. Of these, only patients with proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME) were included in the study. Glycemic control was determined by subtracting patients’ most recent HbA1C at the time of data collection from HbA1C at the time of presentation. Visual acuity was measured at the first GEC visit and at 1, 3, and 6 month follow-up visits. Change in visual acuity was calculated by subtracting patients’ most recent visual acuity (in logMAR) from visual acuity at presentation.
271 patients with PDR or DME were reviewed with visual acuities tracked for each eye (total of 542 eyes). Of these, 318 visual acuities were documented at the GEC following teleretina screening. 135 eyes had no additional follow-up and were therefore excluded from this analysis. Of the remaining 183 eyes, 96 were followed for 6 months, 69 for 3 months, and 18 for 1 month. The relationship between change in A1C vs. change in visual acuity is plotted in Figure 1.
These results suggest that even diligent glycemic control may not protect patients from declining visual acuity. Still, the results do not deny the importance of tight glycemic control in avoiding diabetic eye complications. Rather, they suggest there may be external factors that influence patients’ progression after follow-up. Further research with larger sample sizes should focus on identifying variables with stronger predictive values. Additional efforts could be taken to identify barriers to follow up after initial teleretina screening.
This is a 2020 ARVO Annual Meeting abstract.
This PDF is available to Subscribers Only