Abstract
Purpose :
Vitreous hemorrhage (VH) is a common complication of proliferative diabetic retinopathy (PDR) that can have serious vision- and life-altering consequences. We conducted a cross-sectional, electronic health record (EHR)-based study to identify factors associated with VH development, recurrence risk, surgical intervention, treatment costs, and elements linked to favorable visual acuity (VA) outcomes in patients with diabetic retinopathy (DR).
Methods :
A retrospective review of patients who had DR and were seen at an academic medical center between June 2020 and May 2023 was conducted. Patient demographics, clinical characteristics, and Healthcare Effectiveness Data and Information Set (HEDIS) metrics were extracted from the EHR using a custom reporting tool. Multivariate logistic regression identified factors associated with VH development and outcomes. Cost analysis estimated the financial burdens of VH diagnosis and management.
Results :
Out of 2709 patients with DR, 275 eyes from 219 patients (8.1%) had at least one VH due to PDR. Bilateral VHs occurred in 35% of cases and constituted the initial presenting diagnosis to ophthalmology in 2.2% of cases. Bilateral VHs were associated with elevated body mass index (BMI) > 30 (P=0.016). Patients with poor VA outcomes were more likely to be female (P=0.022). Recurrent VHs occurred in 45% of eyes. Factors associated with recurrence included male sex (P=0.016), lack of prior DR treatment (P=0.036), and absence of microalbumin testing within the last year (P<0.001). Worse VA at initial presentation (P<0.001) and 30 days after presentation (P<0.001) were associated with a higher likelihood of receiving surgical treatment. Finally, the average cost per VH event was estimated at $2810 by 180 days post-VH or resolution. Patients requiring surgery incurred a higher total cost per event (P<0.001).
Conclusions :
VHs are a common and costly complication of DR. Our study highlights modifiable factors linked to the development of VH as well as poor outcomes, including a lack of prior treatment for DR, absence of laboratory testing, and elevated BMI. Surgery was associated with greater financial costs but was not independently associated with better outcomes. Treatment of DR prior to a VH event is associated with reduced risk of recurrence.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.