June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Progression and Regression of Diabetic Retinopathy in the IRIS® Registry (Intelligent Research in Sight)
Author Affiliations & Notes
  • Arthur Brant
    Stanford University, Stanford, California, United States
  • Kapil Mishra
    Stanford University, Stanford, California, United States
  • Ashton Tristan Perlroth
    Stanford University, Stanford, California, United States
  • Henry Bair
    Stanford University, Stanford, California, United States
  • Christine Xu
    Stanford University, Stanford, California, United States
  • Suzann Pershing
    Stanford University, Stanford, California, United States
    VA Palo Alto Health Care System, Palo Alto, California, United States
  • Diana V Do
    Stanford University, Stanford, California, United States
  • Footnotes
    Commercial Relationships   Arthur Brant None; Kapil Mishra None; Ashton Perlroth None; Henry Bair None; Christine Xu None; Suzann Pershing Research to Prevent Blindness, Code F (Financial Support), NEI P30EY026877, Code F (Financial Support); Diana Do Novartis, Code C (Consultant/Contractor), Regeneron, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor), Kodiak Sciences, Code C (Consultant/Contractor), Steve Zelencik Retina Research Fund, Code F (Financial Support), Gregory Wallace Retina Research Fund, Code F (Financial Support), Boeringer Ingelheim, Code F (Financial Support)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2175 – F0238. doi:
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      Arthur Brant, Kapil Mishra, Ashton Tristan Perlroth, Henry Bair, Christine Xu, Suzann Pershing, Diana V Do; Progression and Regression of Diabetic Retinopathy in the IRIS® Registry (Intelligent Research in Sight). Invest. Ophthalmol. Vis. Sci. 2022;63(7):2175 – F0238.

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

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Abstract

Purpose : Diabetic Retinopathy (DR) is a leading cause of blindness in the United States. While many studies have assessed incidence and prevalence of DR, understanding of odds of transitions between mild, moderate, severe, and proliferative DR is limited. We generate a Markov Model to quantify DR progression and regression, and highlight disparities in DR course based on patient characteristics.

Methods : We identified patients with a new diagnosis of mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, or proliferative diabetic retinopathy (PDR) in 2016 in the IRIS Registry database. Within each category, we analyzed the percentage of eyes whose DR progressed (to more severe disease) or regressed (to milder disease) over a two-year period from disease onset. We stratified analyses by patient characteristics, including age, sex, race, and insurance.

Results : In 2016, 202,777 eyes had a new diagnosis of mild NPDR, 92,319 moderate NPDR, 32,471 severe NPDR, and 125,289 PDR. Within two years, 1.57% of mild NPDR eyes developed PDR, 4.56% of moderate NPDR developed PDR, and 9.64% of severe NPDR developed PDR. 5.43% of eyes with PDR regressed to NPDR within two years. Among eyes with moderate DR, 5.93% regressed to mild NPDR and 7.87% progressed to severe NPDR or PDR. Among eyes with severe NPDR, 10.01% regressed to mild/moderate NPDR and a 9.64% progressed to PDR. Greater progression from NPDR to PDR was observed in patients with Hispanic race (2.48%), age 21 to 40 years (2.27%), and Medicaid insurance (2.12%). Less progression was observed in those of white race (1.37%), age 81-100 years (1.04%), and commercial insurance (1.60%). Regression from PDR to NPDR was most frequent in Asians (7.38%), ages 61-80 (5.78%), and VA insurance (6.20%), and least frequent in black patients (4.77%), ages 21 to 40 (3.91%), and Medicaid (4.76%) insurance.

Conclusions : We identified four key findings: (1) patients with more advanced NPDR more often progress to PDR (6x more often in severe NPDR vs. mild NPDR); (2) The vast majority of eyes neither progressed nor regressed over 2 years; (3) Moderate NPDR progressed 32% more often than it regressed, whereas severe NPDR regressed 4% more often than progressed; (4) Hispanics, ages 21-40, and Medicaid patients most often progressed, while Asians, ages 61-80, and VA insurance patients most often regressed.

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

 

 

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