June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Association between diabetic macular edema and mortality independent of retinopathy (R) grade - The North East London Diabetic Eye Screening Programme (DESP) Study
Author Affiliations & Notes
  • Abraham Olvera-Barrios
    Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
    University College London Institute of Ophthalmology, London, London, United Kingdom
  • Christopher G Owen
    Population Health Research Institute, St. George's University of London, London, United Kingdom
  • John Anderson
    Homerton Healthcare NHS Foundation Trust, London, London, United Kingdom
  • Ryan Chambers
    Homerton Healthcare NHS Foundation Trust, London, London, United Kingdom
  • Louis Bolter
    Homerton Healthcare NHS Foundation Trust, London, London, United Kingdom
  • Alasdair Warwick
    University College London Institute of Cardiovascular Science, London, London, United Kingdom
  • Yue Wu
    Department of Ophthalmology, University of Washington, Seattle, Washington, United States
  • Roshan Welikala
    Kingston University Department of Computer Science, Kingston upon Thames, London, United Kingdom
  • Jiri Fajtl
    Kingston University Department of Computer Science, Kingston upon Thames, London, United Kingdom
  • Sarah Barman
    Kingston University Department of Computer Science, Kingston upon Thames, London, United Kingdom
  • Emily Y. Chew
    Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, United States
  • Frederick L Ferris
    Ophthalmic Research Consultants, Charlotte, North Carolina, United States
  • Aaron Y Lee
    Department of Ophthalmology, University of Washington, Seattle, Washington, United States
    Roger and Angie Keralis Johnson Retina Center, Seattle, Washington, United States
  • Adnan Tufail
    Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
    University College London Institute of Ophthalmology, London, London, United Kingdom
  • Catherine A Egan
    Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
    University College London Institute of Ophthalmology, London, London, United Kingdom
  • Alicja R Rudnicka
    Population Health Research Institute, St. George's University of London, London, United Kingdom
  • Footnotes
    Commercial Relationships   Abraham Olvera-Barrios None; Christopher Owen None; John Anderson None; Ryan Chambers None; Louis Bolter None; Alasdair Warwick None; Yue Wu None; Roshan Welikala None; Jiri Fajtl None; Sarah Barman None; Emily Chew None; Frederick Ferris None; Aaron Lee Santen, Code F (Financial Support), Genentech, Code F (Financial Support), FDA, Code F (Financial Support), Johnson and Johnson, Code F (Financial Support), Carl Zeiss Meditec, Code F (Financial Support), Gyroscope, Code F (Financial Support), Regeneron, Code F (Financial Support), Microsoft, Code S (non-remunerative); Adnan Tufail Allergan, Code C (Consultant/Contractor), Adverum, Code C (Consultant/Contractor), Annexon, Code C (Consultant/Contractor), Apellis, Code C (Consultant/Contractor), Bayer, Code C (Consultant/Contractor), Genetech, Code C (Consultant/Contractor), Heidelberg Engineering, Code C (Consultant/Contractor), Bayer, Code F (Financial Support); Catherine Egan Heidelberg Engineering, Code C (Consultant/Contractor), Inozyme Pharma, Code C (Consultant/Contractor); Alicja Rudnicka None
  • Footnotes
    Support  National Institute for Health and Care Research (NIHR) award ID: AI_HI200008; Wellcome Trust Collaborative Award Grant number: 224390/Z/21/Z.
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2283. doi:
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    • Get Citation

      Abraham Olvera-Barrios, Christopher G Owen, John Anderson, Ryan Chambers, Louis Bolter, Alasdair Warwick, Yue Wu, Roshan Welikala, Jiri Fajtl, Sarah Barman, Emily Y. Chew, Frederick L Ferris, Aaron Y Lee, Adnan Tufail, Catherine A Egan, Alicja R Rudnicka; Association between diabetic macular edema and mortality independent of retinopathy (R) grade - The North East London Diabetic Eye Screening Programme (DESP) Study. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2283.

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

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Abstract

Purpose : The UK DESPs offer annual diabetic eye screening to all people with diabetes aged ≥12 years. We examined associations of all-cause mortality in people undergoing population diabetic eye screening in the North East London DESP.

Methods : Retrospective cohort study (Jan 2012-Dec 2021) from the North East of London DESP with 176,876 people with diabetes. Cox model adjusting for age, sex, ethnicity, type and duration of diabetes, diabetic retinopathy (DR) severity (coded as per NSC-UK classification system in order of increasing severity: R0M0, R1M0, R1M1, R2M0, R2M1, R3M0, R3M1), and deprivation (quintiles of the index of multiple deprivation) examined associations with all-cause mortality.

Results : There were 28,988 deaths over a median of 7.91 years (IQR 4.47-10.19). Compared with people with no retinopathy at first screen, people with R3M1 had a 2.40-fold increase in hazards of death (95%CI 2.18-2.64, p<0.001). Each step rise in DR severity was associated with a 19% increase in hazards of death (p linear trend <0.001). Compared with white people, non-white ethnicities showed lower hazards of death, with Chinese (HR 0.51, 95%CI 0.43-0.61), any other Asian (HR 0.54, 95%CI 0.50-0.57), and south Asian (HR 0.64, 95%CI 0.62-0.66) people showing the greater effect sizes. Compared to people with highest deprivation, the least deprived people showed a HR of 0.73 (95%CI 0.69-0.77, p linear trend <0.001). Males had a 23% increase in hazards of death when compared to females (p<0.001). Every 5-year rise in duration of diabetes was associated with a 9% increase of hazards of death (p<0.001). Every 5-year increase in age at first screen showed a 54% increase in hazards of death (p for linear trend <0.001) and all reported HR are mutually adjusted for all covariates.

Conclusions : DR at first screen is an important determinant of all-cause mortality in diabetic eye screening. Diabetic macular edema increases the risk of death independent of R grade. In a universal healthcare setting where health care delivery is limited by system capacity rather than by patient’s economic circumstances, such as the NHS, deprivation is still associated with mortality. Further work including laboratory and fundus images is needed to obtain better models to stratify people at risk of major diabetes complications from their first DR screening visit.

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

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