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

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.