Extracts from an article that first appeared in Insight July issue.

Of an estimated 1.7 million Australians living with diabetes, approximately 25-35% are likely to experience some form of diabetic retinopathy – meaning potentially 600,000 Australians are at risk of preventable vision loss.

Early detection and treatment are key to preventing vision loss from diabetic retinopathy.

Specsavers is committed to reducing vision loss in people with diabetes by improving timely detection of diabetic retinopathy and access to the collaborative eyecare ecosystem, while also using our data to shed light on patient care within that ecosystem.

Referrals and the effect of COVID-19

Since 2018, 5.5% of Specsavers patients with diabetes have been referred for specialist management. Of these, 14%  had retinopathy classified as minimal (64% of these patients had another referrable condition, such as glaucoma or cataract, at time of referral), 35% (2% of all patients with diabetes) as mild-moderate, 8% (0.4% of all patients with diabetes) as severe and 5% (0.3% of all patients with diabetes) as proliferative diabetic retinopathy.

This breakdown follows reported relative frequencies of the different levels of diabetic retinopathy among patients with diabetes. Interestingly, there is little difference in retinopathy prevalence between patients under 50, and those over 50, though proliferative retinopathy appears slightly more common in younger patients.

In comparison with epidemiological studies, data based on optometric referrals will likely always give lower estimates for retinopathy. In line with the RANZCO referral pathway for diabetic retinopathy, many patients with less severe retinopathy will be managed by optometrists. These patients will hence not appear in referral data, potentially skewing these numbers lower.

There was a defined ‘spike’ in referrals during national COVID-19 restrictions. This can be explained by changes in the type of care provided in this period. While the percentage of patients with diabetes presenting during this period was relatively stable, the total volume of patients with diabetes dropped. It is likely that patients at low risk of retinopathy deferred appointments, skewing the nature of attendances towards urgent and severe diabetic retinopathy, which are more likely to require referral.

In addition, in the past two years, 12.6% of patients referred for diabetic eye disease were referred more than once, with an average 364 days between referrals. Of these patients, 50% were referred with the same level of retinopathy, and 30% were referred with more severe retinopathy. Concerningly, 16% of these patients initially referred with severe NPDR were referred again with proliferative retinopathy. This speaks clearly to the need for a strong collaborative approach to diabetic eyecare, ensuring patients with diabetes are reviewed regularly, even after referral, and referred again should the need arise.