Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan natives
Open accessAbstract
BACKGROUND: Diabetes 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. METHODS: This 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. RESULTS: Prevalence 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. CONCLUSIONS: Prevalence 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.
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Well-controlled DM patients with no baseline retinopathy can be safely screened every 2-3 years.
“Annual examinations have long been recommended as the standard approach, but data suggest that individualized risk assessment and persons with well-controlled DM and no retinopathy at baseline can be safely examined at 2- to 3-year intervals.501,502”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [501]
The Results and Table 5 (page unavailable) report retinopathy prevalence by glycemic control, but do not assess the safety of different screening intervals. A search for 2–3-year intervals and risk-based screening found no passage recommending that schedule for well-controlled patients without baseline retinopathy. (LLM, conf=0.76)
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- Authors
- Bursell, S.-E., Fonda, S. J., Lewis, D. G., & Horton, M. B.
- Affiliations
- University of Hawaiʻi at Mānoa (US)
- Phoenix Indian Medical Center (US)
- Corresponding author
- Horton, Mark B.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-06-20
- Volume
- 13
- Issue
- 6
- Pages
- e0198551
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6010214
- OpenAlex
- W2809637408
- Cited by
- 68
- References
- 45
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 12 · 2021: 16 · 2020: 9 · 2019: 11
- FWCI
- 9.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/publicdomain/zero/1.0/ (vor)
- Locations
- PLoS ONE (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
- Keywords
- diabetic retinopathy, diabetic macular edema, American Indians and Alaska Natives, prevalence, teleophthalmology, primary care, non-proliferative diabetic retinopathy, proliferative diabetic retinopathy, HbA1c, insulin use, diabetes duration
- MeSH terms
- Alaska Natives, Alaskan Natives, Adult, Age Factors, Aged, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Fundus Oculi, Glycated Hemoglobin, Humans, Indians, North American, Lasers, Macular Edema, Male, Middle Aged, Ophthalmology, Ophthalmoscopy, Photography, Population Surveillance, Primary Health Care, Retrospective Studies, United States, Selection Bias, Prevalence, Telemedicine, Genetic Predisposition to Disease, American Indian or Alaska Native
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