T Eugene Day1, Nathan Ravi2, Hong Xian3, Ann Brugh4. 1. VA St. Louis Healthcare System, USA. Electronic address: dayt@email.chop.edu. 2. VA St. Louis Healthcare System, USA; Washington University in St. Louis School of Medicine, USA. 3. VA St. Louis Healthcare System, USA; St. Louis University School of Public Health, USA. 4. VA St. Louis Healthcare System, USA.
Abstract
OBJECTIVE: To examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk. METHODS: Simulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans--using abstracted data from a retrospective cohort of real-world diabetic Veterans--with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group. RESULTS: Diabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98). CONCLUSIONS: Increasing the screening interval for diabetic patients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss. Published by Elsevier Ltd.
OBJECTIVE: To examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk. METHODS: Simulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans--using abstracted data from a retrospective cohort of real-world diabetic Veterans--with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group. RESULTS:Diabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98). CONCLUSIONS: Increasing the screening interval for diabeticpatients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss. Published by Elsevier Ltd.
Authors: Lauren F Laker; Elham Torabi; Daniel J France; Craig M Froehle; Eric J Goldlust; Nathan R Hoot; Parastu Kasaie; Michael S Lyons; Laura H Barg-Walkow; Michael J Ward; Robert L Wears Journal: Acad Emerg Med Date: 2017-09-21 Impact factor: 3.451
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