Abstract
Purpose :
Though there are no population-based screening recommendations for glaucoma, screening in at-risk populations has proven beneficial. Ocular coherence tomography (OCT) is a popular tool for assessing structural damage from glaucoma. The purpose of this study is to determine the utility of OCT for glaucoma screening in a population of diabetic patients. These results may inform future screening practices for early detection of glaucoma.
Methods :
In this prospective study, patients with diabetes were screened for diabetic eye disease at a Duke primary care clinic over six months. The current study is a post-hoc analysis of OCT data collected from these patients. Glaucoma suspects (GS) were identified based on abnormal retinal nerve fiber layer (RNFL) thickness on OCT. Two-dimensional fundus photos of GS were graded by two independent raters for cup-to-disc ratio (CDR), image quality, and presence of optic disc notching, rim thinning, or disc hemorrhage.
Results :
Of the 807 subjects that were screened, 50 patients (6.2%) were identified as GS due to abnormal RNFL thickness in at least one eye. The cohort of GS was 44% female and 70% white. Mean RNFL thickness for GS was significantly lower than mean RNFL in the total screening population (p<0.001). Median CDR for GS was 0.44. Twenty-eight eyes of 17 GS were marked as having optic disc notching or rim thinning by at least one grader, while 13 eyes of 7 GS were marked by both graders. Racial differences showed that mean CDR was significantly higher in non-whites than whites (p<0.001). Patient age was negatively correlated with RNFL (r=-0.29, p=0.004).
Conclusions :
The aim of this study was to determine the percentage of diabetic patients categorized as GS by OCT and elicit how many suspects also showed clinical signs of glaucomatous damage. Results of this study suggest that in a sample of diabetic patients, a small but clinically significant minority may be flagged as GS based on OCT. Nearly one-fifth of these suspects demonstrated clinical signs of glaucoma on fundus evaluation. The construction of screening guidelines for glaucoma remains an important discussion in primary prevention of the disease. These results suggest that screening with OCT may be warranted in certain populations to allow for earlier diagnosis and treatment, particularly in older, non-white patients with diabetes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.