Diabetic retinopathy: more patients, less laser: a longitudinal population-based study in Tayside, Scotland.

OBJECTIVE: We aim to correlate the incidence of diabetic retinopathy and maculopathy requiring laser treatment with the control of risk factors in the diabetic population of Tayside, Scotland, for the years 2001-2006. RESEARCH DESIGN AND METHODS: Retinal laser treatment, retinal screening, and diabetes care databases were linked for calendar years 2001-2006. Primary end points were the numbers of patients undergoing first or any laser treatment for diabetic retinopathy or maculopathy. Mean A1C and blood pressure and retinal screening rates were followed over the study period.
RESULTS: Over 6 years, the number of patients with diabetes in Tayside increased from 9,694 to 15,207 (57% increase). The number of patients receiving laser treatment decreased from 222 to 138 and first laser treatments decreased from 100 (1.03% of diabetic population) to 56 (0.37%). The number of patients with type 2 diabetes treated for maculopathy decreased from 180 in 2001 to 103 in 2006 (43% reduction, P = 0.03). Mean A1C decreased for type 1 and type 2 diabetic populations (P < 0.01) and a reduction in blood pressure was observed in type 2 diabetic patients (P < 0.01). The number of patients attending annual digital photographic retinopathy screening increased from 3,012 to 11,932.
CONCLUSIONS: Laser treatment for diabetic maculopathy in type 2 diabetic patients has decreased in Tayside over a six-year period, despite an increased prevalence of diabetes and increased screening effort. We propose that earlier identification of type 2 diabetes and improved risk factor control has reduced the incidence of maculopathy severe enough to require laser treatment.