Fundus examination dropouts for diabetic retinopathy patients after COVID-19: a retrospective cohort study of Japan’s national database

Abstract

Purpose : The COVID-19 pandemic significantly decreased the number of fundus examinations in Japan which significantly impacted the treatment of patients with diabetic retinopathy (DR). We conducted a retrospective cohort study using the national database in Japan to determine patient’s dropout rate from fundus examinations for DR and the associated risk factors after the COVID-19 pandemic.

Methods : This cohort study was conducted using the database from the Japan Medical Data Center Inc. (Tokyo, Japan). The study period was from April 2018 to March 2021. Patients who had diagnosis-related codes and medication codes for diabetes were identified as patients with diabetes (PwD). PwD who had more than one examination in each of the years 2018 and 2019 were identified as the regular visit group. Of the regular visit group, those with no visits between April 2020 and March 2021 (Japan declared a COVID-19 emergency) were defined as the dropout group. Multiple logistic regression analysis was used to identify the risk factors from the dropout group.

Results : From the database, 85,910 patients met the defined criteria for PwD. Of those patients, 14,845 patients were identified as the regular visit group. The rate of the dropout group was 15.7% (n=2,333/14,845). The following odds ratios (95% confidence intervals) were statistically significant factors of the dropout group. Ages 40 to 50 years old were 0.65 (0.495-0.857), ages 50 to 60 years old were 0.61 (0.465-0.791), ages 60 years old or older (vs. under 40 age) were 0.51 (0.385-0.663), male sex was 1.21 (1.080-1.364), body mass index less than 18.5% (vs. 18.5 to 24.9%) was 0.66 (0.457-0.957), hemoglobin A1c (HbA1c) 7.0% to 9.0% was 0.81 (0.731-0.888), HbA1c 9.0% or more vs. under 7.0% was 0.81 (0.675-0.967), triglycerides were 1.18 (1.067-1.313)), γ-Glutamyl TransPeptidase was 1.20 (1.066-1.344).

Conclusions : Due to the COVID-19 pandemic, 15.7% of PwD dropped out from their regular fundus examination to treat DR, and the risk factor for dropout was well-controlled HbA1c (under 7.0%). DR was worse for patients with not only hyperglycemia but also other abnormalities, such as hypertension and dyslipidemia, thus patients with well-controlled HbA1c may have worse DR due to dropout. The progression of DR may worsen as regular fundus examinations and comorbidities change under the COVID-19 pandemic.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.