June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes
Author Affiliations & Notes
  • Charumathi Sabanayagam
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore, Singapore
    The Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-NUS Medical School, Singapore, Singapore
  • Feng He
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore, Singapore
  • Haslina Hamzah
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore, Singapore
  • Tien Yin Wong
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore, Singapore
    The Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-NUS Medical School, Singapore, Singapore
  • Ching-Yu Cheng
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore, Singapore
    The Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-NUS Medical School, Singapore, Singapore
  • Gavin Tan
    Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore, Singapore
    The Ophthalmology & Visual Sciences Academic Clinical Programme (EYE ACP), Duke-NUS Medical School, Singapore, Singapore
  • Footnotes
    Commercial Relationships   Charumathi Sabanayagam None; Feng He None; Haslina Hamzah None; Tien Yin Wong None; Ching-Yu Cheng None; Gavin Tan None
  • Footnotes
    Support  NMRC/OFLCG/001/2017
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 818. doi:
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    • Get Citation

      Charumathi Sabanayagam, Feng He, Haslina Hamzah, Tien Yin Wong, Ching-Yu Cheng, Gavin Tan; Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes. Invest. Ophthalmol. Vis. Sci. 2022;63(7):818.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To longitudinally examine the transitions in diabetic retinopathy (DR) severity over time and determine which state deteriorates rapidly in an Asian population with diabetes.

Methods : We analysed 20453 clinic visits by 9481 Chinese, Malay and Indian adults diagnosed with diabetes who attended the annual DR screening visits in primary care clinics as part of the Singapore Integrated Diabetic Retinopathy Screening (SiDRP) programme from 2010-2015 and linked to death data at Ministry of Health. DR was assessed from retinal photographs and graded for severity by professional graders. We applied a multistate Markov model to estimate the annual transition probabilities between states (none, mild, moderate and severe/proliferative DR and the absorbing state, death), and the expected waiting time in each state (sojourn time) adjusted for risk factors including age, sex, systolic blood pressure (SBP), duration of diabetes, HbA1c, and body mass index (BMI).

Results : The median time between assessments was 12 months, and the majority of patients had at least 3 assessments. The annual transition probability from none-to-mild, mild-to-moderate and moderate-to- severe in the adjusted model were 6.1%, 7.0% and 19.1% and of death from each state were 1.2%, 2%, 19.1%, and 29.8%; mean time spent in each state (sojourn time) were 8.2, 0.8, 0.8 and 2.2 years. While 0.1% progressed from none-to-severe DR, 1.9% progressed from mild-to-severe DR; Probability of regression from mild-to-none, moderate-to-mild and severe-to-moderate DR were: 55.4%, 17.1% and 4.3%. While 12.4% regressed from moderate-to-none, 0.4% regressed from severe DR-to-none. Higher levels of HbA1c and SBP were associated with progression of none-mild and mild-moderate DR and duration of diabetes with no-mild and moderate to severe/proliferative DR. Lower levels of HbA1c were associated with regression from mild-to-none and moderate-to-mild; higher BMI with mild-to-none DR.

Conclusions : Our results suggest that the mean time to develop mild DR was long (~8 years), while transitions from mild or moderate states were faster within a year. Moderate/above DR greatly increases the probability of progression and death as compared to mild DR/below. HbA1c was associated with both progression as well as regression.

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

 

Figure 1. Annual state transitions of DR in the Markov Model

Figure 1. Annual state transitions of DR in the Markov Model

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