50-OR: Identifying Risk of Blindness in Patients with Diabetic Retinopathy

Purpose: Using real-world data from the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight), this retrospective study sought to identify risk factors for developing sustained blindness (SB) in eyes with newly diagnosed diabetic retinopathy (DR). Methods: IRIS Registry data were reviewed to identify eyes newly diagnosed with DR between Jan 1, 2013 and Dec 31, 2017 (index date). Included eyes had ≥ 2 visual acuity (VA) readings of 20/40 or better before or ≤ 3 months post index; eyes with evidence of prior DR, retinal disease or retinal treatment were excluded. Patients were followed until the development of SB (defined as ≥ 2 VA readings of 20/200 or worse ≥ 3 months apart), or most recent VA reading. Kaplan-Meier analyses estimated time to SB by DR severity; multivariable Cox proportional hazards models assessed the impact of baseline characteristics and ocular conditions during follow-up on the risk of developing SB. Results: A total of 53,535 eyes were analyzed, 678 of which developed SB during follow-up. At index, 49.4% of eyes were diagnosed with mild non-proliferative DR (NPDR), 9.1% moderate NPDR, 1.5% severe NPDR, 10.5% proliferative DR (PDR), and 29.5% unspecified DR. Relative to eyes with mild NPDR at index, eyes diagnosed with severe NPDR and PDR were 3.6 and 4.0 times more likely to develop SB within 2 years, respectively. Factors associated with increased risk of developing SB included black (hazard ratio (HR), 1.24; P < 0.0001) and Asian race (1.27; P < 0.011), female sex (HR 1.08; P = 0.01), and enrollment in Medicare or Medicaid compared with private plans (HR 0.70-0.91; P < 0.05), in addition to diabetic macular edema and retinal vein occlusion during follow-up (HR 1.96-4.91; P < 0.0001). Conclusions: Our model identified that race, sex, and other characteristics can predict likelihood of developing SB in patients with DR. Close monitoring or early intervention should be considered for patients who are black or Asian race, female, or have developed other ocular conditions.