Retinopathy screening attendance ‘suboptimal’ in young adults with diabetes
medwireNews: Results from a UK retrospective study suggest that there is “considerable variation” in diabetic eye screening attendance in different age groups, with the worse attendance rates among younger people.
“This is likely to have major consequences in terms of the risk of developing sight-threatening diabetic eye disease,” say the researchers.
John Lawrenson (City University of London, UK) and colleagues from the EROS Study Group used a screening software platform to collect anonymized data from three urban regional screening programs in England.
Out of the 97,048 newly registered eligible individuals, the majority (92%) of whom had type 2 diabetes, 16% did not go to their first screening appointment within 40 months from registration, and approximately 3% of those who were screened had referable retinopathy. Kaplan–Meier analysis showed that overall, 78% of people went to their first screening date within 6 months of registration, 80% by the first year, and 88% by the third year after registration.
While these findings show that “the majority of participants are screened in a timely manner, there is considerable variation in uptake” between age groups, with suboptimal attendance in young adults, write Lawrenson et al in Diabetic Medicine.
Time to first screening was greatest for participants aged 18–34 years (n=8710) at registration, and 26% of this group had not attended screening at the 3-year follow-up. Logistic regression analysis showed that people in this age group had a significantly higher risk for referable retinopathy than those aged 35–59 years, with an odds ratio (OR) of 1.26. Moreover, the authors found “[t]he that longer the interval between registration and screening attendance, the more likely the individual was to have referable retinopathy,” at an OR of 1.83 when comparing screening attendance at 12–35 months versus attendance within 2 months.
The study also included 291,296 individuals in a second larger cohort, which allowed the team “to undertake a more granular analysis of the relationship between age and ongoing screening attendance.”
Only 5% of participants of this group did not attend screening during 15 months of follow-up, but again there was substantial variable between age groups, say the researchers, with patients over 60 years having a lower non-attendance rate than younger patients. In particular, patients aged 24–29 years were significantly less likely to attend screening, and significantly more likely to have referable retinopathy, than those aged 60 years and older, with ORs of 0.31 and 1.85, respectively, when adjusting for factors such as sex, ethnicity, and diabetes type.
The researchers also report that annual incidence of vision impairment in patients below 35 years has not changed during the last decade. However, there was a reduction for participants aged 65 years or older, with a “less pronounced” decrease for those aged 35–59 years.
“There is an urgent need to understand factors influencing retinopathy screening attendance in young adults to inform targeted interventions and policy initiatives to improve uptake,” concludes the team.
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