Risk factors associated with diabetic retinopathy and vision diagnosed by a teleophthalmology program

Abstract

Purpose : To report on the level of and associated demographic and systemic health factors for diabetic retinopathy (DR) and distance visual acuity (VA) as determined in a primary care based teleophthalmology program for an underserved urban population.

Methods : A retrospective review was performed of prospectively collected, cross-sectional data from a teleophthalmology program to evaluate patients with a diagnosis of diabetes who had not had a documented eye exam in the last year. The analysis used data from six urban primary care sites within a single health system between 2015-2021. Demographic factors, including age, race, ethnicity, and sex and systemic health related information, including blood pressure, smoking status, last HbA1c, and health insurance were associated with VA level and presence and level of DR using single and multivariate linear and logistic regressions with significance set at a p-value less than 0.05.

Results : 1,232 patients were evaluated for DR, 166 (13.5%) had DR and, of those, 82 (49.4%) cases were deemed vision threatening (VTDR) due to presence of diabetic macular edema (macular hard exudates) and/or severe non-proliferative DR or worse. No variables were identified as multicollinear with DR or VA outcome for multiple regression analysis. HbA1c greater than 7.0 (p<0.005), increased age (p<0.014), and African American race (p<0.005) were correlated with worse VA. No other variable was significantly associated with VA. A 1.0 unit increase in HbA1c increased the odds for DR by 1.24 (p<0.005; 95% CI 1.20, 1.29) times while only patients under dual Medicare/Medicaid insurance appeared to be 1.96 (p=0.051; 95% CI 1.00, 3.87) times as likely of having DR than commercial payors, controlling for other variables. VTDR was 2.93 (p<0.005; 95% CI 1.89, 4.53) times as likely with elevated HbA1c. Neither age, sex, smoking status, race nor level of blood pressure control appeared to confer a significantly higher odds ratio for DR or VTDR.

Conclusions : HbA1c remains a key variable associated with worsening VA and DR in patients evaluated via teleophthalmology with demographic factors such as age and being a minority as well as having certain health insurances correlating with worse VA and increased risk of DR, respectively. Further research is needed to clarify these relationships and their impacts on long-term health outcomes in a safety-net population with diabetes.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.