Two-Year Incidence of Retinal Intervention in Patients With Minimal or No Diabetic Retinopathy on Telemedicine Screening

Question  What is the 2-year rate of retinal intervention in patients with minimal or no diabetic retinopathy on telemedicine screening?

Findings  In this cohort study, 11 of 69 364 patients with no baseline retinopathy and 11 of 9811 patients with minimal baseline retinopathy required a retinal intervention because of diabetic eye disease within 2 years of the baseline evaluation.

Meaning  The findings suggest that extending follow-up examinations for patients with minimal or no baseline diabetic retinopathy may be warranted because most may not need retinal intervention within 2 years of initial evaluation, provided this extension does not lead to worse follow-up in later years.

Importance  Most patients with diabetes have little or no retinopathy on initial examination. Tracking the long-term outcomes of these patients may increase our understanding of how to best provide follow-up treatment.

Objective  To assess how many patients with minimal or no retinopathy require retinal intervention within 2 years of retinal evaluation.

Design, Setting, and Participants  This retrospective cohort study assessed patients who underwent screening for diabetic retinopathy within a telemedicine program at Kaiser Permanente Southern California and had minimal or no retinopathy on fundus photographs.

Exposure  Retinal interventions performed within 2 years of photographs.

Main Outcomes and Measures  Patients with minimal or no retinopathy on initial screening photographs taken in 2012 had their medical records searched for Current Procedural Terminology codes for intravitreal injections, retinal lasers, or pars plana vitrectomy. The medical records of patients identified as having received these interventions within 2 years of retinal evaluation were then manually reviewed for further characterization.

Results  Diabetic retinopathy screening photographs were taken for 116 134 patients (mean [SD] age, 58 [12.8] years; 54 582 [47.0%] female; 46 453 [40.0%] Latino). Of these patients, 79 445, including 69 634 patients without retinopathy and 9811 patients with minimal retinopathy, had 2 years of follow-up. Eleven patients without baseline retinopathy required treatment of diabetic retinopathy in the following 2 years (1 of 12 660 or 0.000079 patients per year), and 11 patients with minimal retinopathy required intervention during the same period (1 of 1784 or 0.000561 patients per year). In addition, retinal interventions were performed for conditions not directly related to diabetic eye disease in 44 patients without baseline retinopathy (1 of 3165 or 0.000316 patients per year) and 5 patients with minimal retinopathy at baseline (1 of 3924 or 0.000255 patients per year).

Conclusions and Relevance  These findings suggest that it is rare for patients with minimal or no baseline retinopathy to require retinal interventions in the 2 years after retinal evaluation. It appears that extending the recommended follow-up interval for low-risk patients may be reasonable as long as this does not lead to worse follow-up in later years, because most are unlikely to have vision-threatening disease that necessitates treatment.