Characterization of real-world progression from non-proliferative to proliferative diabetic retinopathy in patients with diabetes

Abstract

Purpose : To characterize baseline, follow-up, and testing attributes of a real-world population with non-proliferative diabetic retinopathy (NPDR) and to report progression to proliferative diabetic retinopathy (PDR).

Methods : Retrospective study of patients with diagnosis of diabetes and NPDR based on clinical exam performed at Cleveland Clinic Cole Eye Institute from January 2012 to February 2020. Patients must have had at least 365 days of follow-up after the NPDR index date, and at least two ophthalmic visits during follow-up. Basic descriptive stats were used for a survival analysis with time to PDR. Diagnosis of PDR was determined by initiation of treatment with anti-VEGF or panretinal photocoagulation (PRP) and an ICD-9 or 10 PDR diagnosis.

Results : The cohort consisted of 4555 patients; 10% (435/4474) developed PDR (23.6 cases per 1000 person-years) during follow-up [median, interquartile range (IQR) = 2.9 years (1.8, 4.1)]. The median age of patients was 66 years at baseline; half were female; 25% were Black, and 4053 (89%) had a diagnosis of type 2 diabetes. 1595 patients (35%) had concurrent eye diseases. On average, each patient had approximately 8 retinal images collected (optical coherence tomography, color fundus photographs and/or fluorescein angiography). Of the patients who received anti-VEGF treatment in the first year after NPDR index date (n=572), the median (IQR) real-world frequency of anti-VEGF injections was 5 (2, 9) in the first year. Of the patients who received PRP in the first year after NPDR index date (n=134), the median (IQR) real-world frequency of PRP was 2 (1, 3) in the first year. Over 80% of patients had 20/40 or better visual acuity (VA) in the right (83%) or left eye (82%) at index date.

Conclusions : Real-world data may provide meaningful insights to the characterization of patients and eyes with NPDR and higher risk of progression to PDR. Further data analysis in this cohort as well as future studies to elucidate how retinal imaging and VA correlate in diabetic retinopathy (DR) may lead to better characterization of DR disease phenotypes and aide in further development of algorithms or therapeutics for DR management at all stages.

This is a 2021 ARVO Annual Meeting abstract.

 

Table 1. Baseline demographics, systemic markers, follow-up time and imaging frequency

 

Fig 1. Baseline VA for left and right eyes [4506 (98.9%) and 4521 (99.3%) VA measurements, respectively]