ABSTRACT

Purpose

Estimates of diabetic eye disease in American Indian and Alaska Natives (AI/AN) vary over time, region, and methods. This article reports recent prevalence of diabetic retinopathy (DR) and diabetic macular edema (DME) in AI/AN served by the Indian Health Services’ (IHS) teleophthalmology program, as identified using ultrawide field imaging (UWFI).

Methods

This was a retrospective analysis of 2016–2019 clinical data (n = 53,900). UWF images were acquired by certified imagers using a validated protocol, and graded by licensed, certified optometrists supervised by an ophthalmologist. Graders evaluated the extent/severity of retinal lesions in comparison to standard photographs. DR lesions predominantly in any peripheral field were considered “predominantly peripheral lesions” (PPL). The analyses calculated prevalence of any DR, any DME, DR and DME severity, sight-threatening disease, and PPL.

Results

Patients averaged 56 years of age with a 68 mmol/mol A1c and 55% had had diabetes for 5+ years. Prevalence of any DR, any DME, and sight-threatening disease was 28.6%, 3.0%, and 3.0%. In patients with mild nonproliferative DR, PPL was seen in 25.3%. PPL suggested a more severe level of DR in 8.7% of patients. DR increased with age. DME decreased with age. Males and patients in the Nashville IHS area had more diabetic eye disease.

Conclusion

AI/AN have a high burden of diabetes and its complications. The IHS is resource-constrained, making accurate disease estimates necessary for resource allocation and budget justifications to Congress. These data update the estimates of diabetic eye disease in Indian Country and suggest that UWFI identifies early DR.

中文翻译：

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印度卫生服务国家远程眼科计划使用超广角成像 (UWFI) 确定美洲印第安人和阿拉斯加原住民 (AI/AN) 糖尿病眼病的患病率

 抽象的

 目的

对美洲印第安人和阿拉斯加原住民 (AI/AN) 糖尿病眼病的估计随时间、地区和方法的不同而变化。本文报告了印度卫生服务 (IHS) 远程眼科项目服务的 AI/AN 中糖尿病性视网膜病变 (DR) 和糖尿病性黄斑水肿 (DME) 的最新患病率，并使用超广角成像 (UWFI) 进行了识别。

 方法

这是对 2016-2019 年临床数据 (n = 53,900) 的回顾性分析。 UWF 图像由经过认证的成像仪使用经过验证的协议获取，并由获得许可的认证验光师在眼科医生的监督下进行分级。分级人员与标准照片相比评估视网膜病变的范围/严重程度。主要发生在任何外周区域的 DR 病变被认为是“主要外周病变”(PPL)。分析计算了任何 DR、任何 DME 的患病率、DR 和 DME 的严重程度、威胁视力的疾病和 PPL。

 结果

患者平均年龄 56 岁，糖化血红蛋白 (A1c) 为 68 mmol/mol，其中 55% 患有糖尿病 5 年以上。任何 DR、任何 DME 和威胁视力的疾病的患病率分别为 28.6%、3.0% 和 3.0%。在轻度非增殖性 DR 患者中，25.3% 出现 PPL。 PPL 表明 8.7% 的患者患有更严重的 DR。 DR 随着年龄的增长而增加。 DME随着年龄的增长而下降。纳什维尔 IHS 地区的男性和患者患有更多糖尿病眼病。

 结论

AI/AN 糖尿病及其并发症的负担很高。 IHS 资源有限，因此需要准确的疾病估计来分配资源并向国会提供预算理由。这些数据更新了印度国家糖尿病眼病的估计，并表明 UWFI 可以识别早期 DR。