Assessing progression and efficacy of treatment for diabetic retinopathy following the proliferative pathway to blindness

Implication for diabetic retinopathy screening in Taiwan

W. J. Liu, L. T. Lee, M. F. Yen, T. H. Tung, R. Williams, S. W. Duffy, Tony Hsiu Hsi Chen

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Aims: The natural history and treatment efficacy of diabetic retinopathy (DR) play important roles in the evaluation of screening. Therefore, the natural history of DR and rates of transition after treatment (including metabolic control and laser photocoagulation) from no diabetic retinopathy (NDR) to blindness were quantified. Methods: We studied a cohort of 795 patients with diabetes mellitus (DM) receiving fundus examination in the ophthalmology out-patient department of one medical centre between 1 January 1990 and 31 December 1992 in Taiwan. Follow-up data until 31 December 1998 were collected by chart review. Two multistate Markov models were proposed to assess the efficacy of the treatment regime in reducing progression to blindness. Results: The average times spent in states (i) no diabetic retinopathy (NDR), (ii) background diabetic retinopathy (BDR), (iii) preproliferative diabetic retinopathy (PPDR), and (iv) proliferative retinopathy (PDR) were 10.86 years, 8.33 years, 1.67 years, and 2.17 years, respectively. Early detection of PPDR may lead to a 60% reduction in PDR and an 83% reduction in blindness. Simulated results based on these parameters show that an annual screening programme, a biennial screening regime and a 4-yearly screening regime can lead to 54% (95% confidence interval (CI): 44-62%), 51% (95% CI: 41-59%), and 46% (95% CI: 36-54%) reductions in blindness, respectively. Conclusions: Assessing the progression of DR following the proliferative pathway in this study suggests that screening for DR is worthwhile and that a 4-year interscreening interval for patients as yet without DR may be justified.

Original languageEnglish
Pages (from-to)727-733
Number of pages7
JournalDiabetic Medicine
Volume20
Issue number9
DOIs
Publication statusPublished - Sep 2003
Externally publishedYes

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Diabetic Retinopathy
Blindness
Taiwan
Confidence Intervals
Light Coagulation
Ophthalmology
Natural History
Diabetes Mellitus
Lasers
Outpatients

Keywords

  • Diabetic retinopathy
  • Markov model
  • Screening

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Assessing progression and efficacy of treatment for diabetic retinopathy following the proliferative pathway to blindness : Implication for diabetic retinopathy screening in Taiwan. / Liu, W. J.; Lee, L. T.; Yen, M. F.; Tung, T. H.; Williams, R.; Duffy, S. W.; Chen, Tony Hsiu Hsi.

In: Diabetic Medicine, Vol. 20, No. 9, 09.2003, p. 727-733.

Research output: Contribution to journalArticle

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abstract = "Aims: The natural history and treatment efficacy of diabetic retinopathy (DR) play important roles in the evaluation of screening. Therefore, the natural history of DR and rates of transition after treatment (including metabolic control and laser photocoagulation) from no diabetic retinopathy (NDR) to blindness were quantified. Methods: We studied a cohort of 795 patients with diabetes mellitus (DM) receiving fundus examination in the ophthalmology out-patient department of one medical centre between 1 January 1990 and 31 December 1992 in Taiwan. Follow-up data until 31 December 1998 were collected by chart review. Two multistate Markov models were proposed to assess the efficacy of the treatment regime in reducing progression to blindness. Results: The average times spent in states (i) no diabetic retinopathy (NDR), (ii) background diabetic retinopathy (BDR), (iii) preproliferative diabetic retinopathy (PPDR), and (iv) proliferative retinopathy (PDR) were 10.86 years, 8.33 years, 1.67 years, and 2.17 years, respectively. Early detection of PPDR may lead to a 60{\%} reduction in PDR and an 83{\%} reduction in blindness. Simulated results based on these parameters show that an annual screening programme, a biennial screening regime and a 4-yearly screening regime can lead to 54{\%} (95{\%} confidence interval (CI): 44-62{\%}), 51{\%} (95{\%} CI: 41-59{\%}), and 46{\%} (95{\%} CI: 36-54{\%}) reductions in blindness, respectively. Conclusions: Assessing the progression of DR following the proliferative pathway in this study suggests that screening for DR is worthwhile and that a 4-year interscreening interval for patients as yet without DR may be justified.",
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