Associating glaucoma and diabetic retinopathy: opportunistic AI-powered glaucoma screening

Abstract

Purpose : Evaluate results of combining an AI-powered glaucoma screening to an established diabetic retinopathy screening protocol.

Methods :
Subset analysis of ongoing prospective study (Clinicaltrial.gov: NCT05875090). Sample of cases where the AI-powered Glaucoma screening was performed in parallel to diabetic-retinopathy screening. Glaucoma-related protocol included intraocular pressure measurement (IOP) and disk-centred fundus photography. An AI algorithm (MONA GLC, MONA.health, Belgium) evaluated the need for referral to ophthalmologist for glaucoma evaluation using the fundus image. Subjects were referred to the glaucoma clinic if either IOP³ 24mmHg or AI output ³ 0.73. Positive patients would subsequently perform OCT and Visual Field testing. VF were analysed according to the ocular hypertension treatment study methodology; structural outcomes were analysed binary (normal vs abnormal) determined by the existence of any sector abnormality (<1%) by the device’s normative database. Diabetic-related data was gathered from patient records. Subjects with concomitant ocular diseases were excluded.

Results : 202 diabetic subjects (aged 60.8±3.6) accepted to participate in the add-on screening (out of 205). Mean time since diabetes diagnosis was 5.9 years (±4.3) and mean hemoglobin A1C was 6.9% (±1.3). Mean IOP and AI scores were 14.4mmHg (±4.0) and 0.54 (±0.12), respectively. Glaucoma screening was positive in 21 subjects (10.3%), 18 of which due to high AI-score and 3 due to high IOP. Twelve (5.9% of the screened cohort) subjects demonstrated glaucomatous VF loss with a mean MD of -8.0dB (±6.96) in affected eyes. Interestingly, only a third of the referred patients (n=8) presented structural anomalies as demonstrated by BMO and RNFL OCT (3.9% of the screened cohort). Only 1 subject had a previous diagnosis of glaucoma. Positive AI scores did not correlate with diabetes duration nor HbA1c levels (p>0.05)

Conclusions : Diabetic subjects seem to have a higher-than-expected frequency of glaucoma. The high incidence of moderate-to-advanced disease in the referred patients coupled with the acceptability of this opportunistic additional testing may prove to be a cost-effective procedure.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.