Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives

Abstract

BackgroundDiabetes and its complications are more common in American Indians and Alaska Natives (AI/AN) than other US racial/ethnic populations. Prior reports of diabetic retinopathy (DR) prevalence in AI/AN are dated, and research on diabetic macular edema (DME) is limited. This study characterizes the recent prevalence of DR and DME in AI/AN using primary care-based teleophthalmology surveillance.MethodsThis is a multi-site, clinic-based, cross-sectional study of DR and DME. The sample is composed of AI /AN patients with diabetes (n = 53,998), served by the nationally distributed Indian Health Service-Joslin Vision Network Teleophthalmology Program (IHS-JVN) in primary care clinics of US Indian Health Service (IHS), Tribal, and Urban Indian health care facilities (I/T/U) from 1 November 2011 to 31 October 2016. Patients were recruited opportunistically for a retinal examination using the IHS-JVN during their regular diabetes care. The IHS-JVN used clinically validated, non-mydriatic, retinal imaging and retinopathy assessment protocols to identify the severity levels of non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), DME, and sight threatening retinopathy (STR; a composite measure). Key social-demographic (age, gender, IHS area), diabetes-related health (diabetes therapy, duration of diabetes, A1c), and imaging technology variables were examined. The analysis calculated frequencies and percentages of severity levels of disease.ResultsPrevalence of any NPDR, PDR, DME, and STR among AI/AN patients undergoing DR teleophthalmology surveillance by IHS-JVN was 17.7%, 2.3%, 2.3%, and 4.2%, respectively. Prevalence was lowest in Alaska and highest among patients with A1c >/ = 8%, duration of diabetes > 10 years, or using insulin.ConclusionsPrevalence of DR in this cohort was approximately half that in previous reports for AI/AN, and prevalence of DME was less than that reported in non-AI/AN populations. A similar reduction in diabetes related end-stage renal disease in the same population and time period has been reported by other researchers. Since these two diabetic complications share a common microvasculopathic mechanism, this coincident change in prevalence may also share a common basis, possibly related to improved diabetes management.

IDF Diabetes Atlas: A review of studies utilising retinal photography on the global prevalence of diabetes related retinopathy between 2015 and 2018

“…In the one study from Canada [25] including only type 2 diabetes the prevalence of any DR, NPDR and PDR was 25.1%, 23.6% and 6.5% respectively. The 2 other studies from Alaska [26] and the USA [27] where the type of diabetes was either not recorded or the population was mixed the prevalence of any DR was 20.2% and 33.9%, NPDR 17.6% and 32.8%, PDR 2.3% and 1.2%, DME 2.3% and 4.3% respectively.…”

“…In North America & Caribbean, Region 4, there were a total of 3 studies [25][26][27] involving 56,518 people with diabetes examined from 2007, 2011 and 2013 onwards, with periods extending over 4-6 years duration ( Table 3). The overall prevalence of any DR, was 21.9%, NPDR 19.5%, PDR 2.5% and DME at 2.5%.…”

Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014

“…These innovative approaches may eliminate an additional appointment to an optometrist or ophthalmologist and could improve screening uptake. Although implemented by the Veterans Health Administration (19), the Indian Health Service (20), and some European countries (21), digital screening has had limited penetration in the U.S. (22).…”

The Diagnostic Accuracy of an Intelligent and Automated Fundus Disease Image Assessment System with Lesion Quantitative Function (SmartEye) in Diabetic Patients

“…Evaluating DR through remote retinal image reading lowers the barriers to eye examination and provides generalized eye healthcare opportunities to DM patients who might not have the opportunity to receive regular eye healthcare 8 . Some example programs include the UK National Health Service Diabetic Eye Screening Program (NHS DESP) 9 and the Indian Health Service (IHS)-Joslin Vision Network (JVN) in the United States 10 . Although both were effective, they depended on trained human graders and substantial investments.…”