Geeta Lalchandani-Lalwani, MD: Diabetic Retinopathy Progression in a Large Dataset

Geeta Lalchandani-Lalwani, MD

It is quite obvious to state that diabetes is certainly a prevalent issue in the United States. With the development of diabetes comes the risk of developing comorbidities, such as diabetic retinopathy. Patients with diabetes must be monitored closely by their healthcare providers so as to find ways to mitigate risk or slow disease progression.

Geeta Lalchandani-Lalwani, MD, ophthalmologist at Boulder Community Health in Colorado, presented a late-breaking study at the American Academy of Ophthalmology (AAO) 2020 Virtual Conference, which assessed the risk of diabetic retinopathy progression in a large population. HCPLive® had the opportunity to speak with her about the study’s findings as well as its clinical implications.

In Part I of the interview, Lalwani broke down the study’s makeup and results, while suggesting a need to increase screening in patients with diabetic retinopathy.

HCPLive: You're presenting a study called, "Insights Into Risk of Diabetic Retinopathy (DR) Progression in Primary Care Patients With Diabetes in the United States." Can you tell me more about it?

Lalwani: Sure. So, we had an interesting database - it was incredibly large and included 22,000 people. That's almost 44,000 eyes. 

In this study, we had a reading center and 2 sets of photos on different time points on each and every one of these eyes. So, that was the criteria that needed to be met in order to be included.

In the reading center, then, we looked at the progression to proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), as well as the 2-step difference in diabetic retinopathy progression over those patients.

Obviously, in a study this large, there were numerous limitations. Unfortunately, screening frequencies were all over the place. The progression to time in PDR, CSME might be underestimated because we didn't follow patients in a specified manner. And really unfortunately, we did not collect clinical factors, including diabetic controlled eating, in these patients.

With that being said, though, it's a very large database of well-done photographs.

HCPLive: Can you say more about the findings of this study as well as their clinical implications?

Lalwani: First, you have to understand the baseline characteristics of these patients. It was a predominantly male population, predominantly white — although, there was an unusual number of Native Americans. Unfortunately, there were smaller numbers of African Americans and Blacks. It was mostly a type 2 diabetic population. 

We found some of the things that we expected to find. The first was that around 10% of eyes had a 2-step DR worsening by year 5. That was all-comers.

If we focused more patients with more severe DR at baseline, we found that they had higher numbers developing 2-step worsening.

For patients who had ETDRS DRSS scores of 43-53, almost 35% of patients worsened at 5 years at 2-step worsening. And if you looked at patients with scores of 47-53, almost 40% of patients had 2-step DR worsening by year 5.

So, that tells clinicians that are managing these patients that if they have patients with out of control diabetes, diabetic retinopathy screening is incredibly important. If they are found to have any degree of diabetic retinopathy or on a more severe scale, they need to be followed closer because their risk of progression is so high. A 35-40% chance of progression in 5 years is quite high.