Referable diabetic retinopathy (DR) rates among patients 80 to 90 years of age are very low, according to research published in Eye. These low progression rates prompted researchers to suggest increasing the patient group’s screening intervals.
Extended screening intervals for DR were implemented in England in 2020 for patients with a low-risk of diabetes-related sight loss. The objective of the study was to characterize the 5-year progression of DR in patients who were either 80 or 85 years of age. The intent was to determine whether these populations could be classified as low-risk for the purpose of extended screening intervals.
The researchers retrospectively assessed data from 2985 patients who were either 80 or 85 years of age at the time of screening in 2014 to 2015 and were followed for 5 years. The outcomes of the study included rates of referable diabetic retinopathy, referral to hospital eye service, and treatment for DR.
Of the 1880 patients in the 80-year cohort, between 3.2% and 3.9% were diagnosed with referable diabetic retinopathy over the course of 5 years. However, actual rates of referral to hospital eye service were only 0.7% to 1.4% and the treatment rate was low at 0.6%. Likewise, 2% to 3.9% of the 1105 patients in the 85-year cohort were diagnosed with referable diabetic retinopathy. However, only 0.1% to 1.3% were referred to hospital eye service and just 0.4% were treated.
The rate of non-DR referrals to hospital eye service for other eye conditions was much higher for both cohorts over the course of 5 years (21% of the 80-year cohort; 13% of the 85-year cohort). Additionally, the rate of screening attendance declined as patients aged, due to death or diseases that made them unsuitable for screening.
These results could be skewed by selection bias of long-lived patients with relatively good health and fewer comorbidities and diabetes complications. Additionally, the study is limited by restricted age cohorts that did not include all patients between age 80 and 90.
However, these findings confirm that the risk of sight-threatening DR is low in patients aged 80 to 90 years. “We propose increasing the screening intervals for persons aged 80 years and over with no referable DR to 5 years to start with as this is a low-risk group. This is a relevant and cost-effective suggestion without compromising patient safety, considering the current national recommendation for low-risk patients and recent increase in screening interval to two years in people with low risk of sight loss,” the researchers report.
Thomas K, Albutt N, Hamid A, Wharton H, Jacob S. Five-year outcomes of digital diabetic eye screening in individuals aged 80 and 85 years. Eye (Lond). 2023;10.1038/s41433-023-02577-x. doi:10.1038/s41433-023-02577-x