To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study
Background The optimal screening interval for diabetic retinopathy (DR) remains controversial. This study aimed to develop a risk algorithm to predict the individual risk of referable sight-threatening diabetic retinopathy (STDR) in a mainly Chinese population and to provide evidence for risk-based...
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Korean Diabetes Association
2025-03-01
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| Series: | Diabetes & Metabolism Journal |
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| Online Access: | http://e-dmj.org/upload/pdf/dmj-2024-0142.pdf |
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| author | Jinxiao Lian Ching So Sarah Morag McGhee Thuan-quoc Thach Cindy Lo Kuen Lam Colman Siu Cheung Fung Alfred Siu Kei Kwong Jonathan Cheuk Hung Chan |
| author_facet | Jinxiao Lian Ching So Sarah Morag McGhee Thuan-quoc Thach Cindy Lo Kuen Lam Colman Siu Cheung Fung Alfred Siu Kei Kwong Jonathan Cheuk Hung Chan |
| author_sort | Jinxiao Lian |
| collection | DOAJ |
| description | Background The optimal screening interval for diabetic retinopathy (DR) remains controversial. This study aimed to develop a risk algorithm to predict the individual risk of referable sight-threatening diabetic retinopathy (STDR) in a mainly Chinese population and to provide evidence for risk-based screening intervals. Methods The retrospective cohort data from 117,418 subjects who received systematic DR screening in Hong Kong between 2010 and 2016 were included to develop and validate the risk algorithm using a parametric survival model. The risk algorithm can be used to predict the individual risk of STDR within a specific time interval, or the time to reach a specific risk margin and thus to allocate a screening interval. The calibration performance was assessed by comparing the cumulative STDR events versus predicted risk over 2 years, and discrimination by using receiver operative characteristics (ROC) curve. Results Duration of diabetes, glycosylated hemoglobin, systolic blood pressure, presence of chronic kidney disease, diabetes medication, and age were included in the risk algorithm. The validation of prediction performance showed that there was no significant difference between predicted and observed STDR risks in males (5.6% vs. 5.1%, P=0.724) or females (4.8% vs. 4.6%, P=0.099). The area under the receiver operating characteristic curve was 0.80 (95% confidence interval [CI], 0.78 to 0.81) for males and 0.81 (95% CI, 0.79 to 0.83) for females. Conclusion The risk algorithm has good prediction performance for referable STDR. Using a risk-based screening interval allows us to allocate screening visits disproportionally more to those at higher risk, while reducing the frequency of screening of lower risk people. |
| format | Article |
| id | doaj-art-8f88df1fa49247acb2e04598b66569d4 |
| institution | DOAJ |
| issn | 2233-6079 2233-6087 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Korean Diabetes Association |
| record_format | Article |
| series | Diabetes & Metabolism Journal |
| spelling | doaj-art-8f88df1fa49247acb2e04598b66569d42025-08-20T03:03:08ZengKorean Diabetes AssociationDiabetes & Metabolism Journal2233-60792233-60872025-03-0149228629710.4093/dmj.2024.01422889To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort StudyJinxiao Lian0Ching So1Sarah Morag McGhee2Thuan-quoc Thach3Cindy Lo Kuen Lam4Colman Siu Cheung Fung5Alfred Siu Kei Kwong6Jonathan Cheuk Hung Chan7 School of Optometry, The Hong Kong Polytechnic University, Hong Kong School of Optometry, The Hong Kong Polytechnic University, Hong Kong School of Public Health, The University of Hong Kong, Hong Kong School of Public Health, The University of Hong Kong, Hong Kong Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong Department of Ophthalmology, The University of Hong Kong, Hong KongBackground The optimal screening interval for diabetic retinopathy (DR) remains controversial. This study aimed to develop a risk algorithm to predict the individual risk of referable sight-threatening diabetic retinopathy (STDR) in a mainly Chinese population and to provide evidence for risk-based screening intervals. Methods The retrospective cohort data from 117,418 subjects who received systematic DR screening in Hong Kong between 2010 and 2016 were included to develop and validate the risk algorithm using a parametric survival model. The risk algorithm can be used to predict the individual risk of STDR within a specific time interval, or the time to reach a specific risk margin and thus to allocate a screening interval. The calibration performance was assessed by comparing the cumulative STDR events versus predicted risk over 2 years, and discrimination by using receiver operative characteristics (ROC) curve. Results Duration of diabetes, glycosylated hemoglobin, systolic blood pressure, presence of chronic kidney disease, diabetes medication, and age were included in the risk algorithm. The validation of prediction performance showed that there was no significant difference between predicted and observed STDR risks in males (5.6% vs. 5.1%, P=0.724) or females (4.8% vs. 4.6%, P=0.099). The area under the receiver operating characteristic curve was 0.80 (95% confidence interval [CI], 0.78 to 0.81) for males and 0.81 (95% CI, 0.79 to 0.83) for females. Conclusion The risk algorithm has good prediction performance for referable STDR. Using a risk-based screening interval allows us to allocate screening visits disproportionally more to those at higher risk, while reducing the frequency of screening of lower risk people.http://e-dmj.org/upload/pdf/dmj-2024-0142.pdfcohort studiesdiabetic retinopathyprognosistime-to-treatmentvision screening |
| spellingShingle | Jinxiao Lian Ching So Sarah Morag McGhee Thuan-quoc Thach Cindy Lo Kuen Lam Colman Siu Cheung Fung Alfred Siu Kei Kwong Jonathan Cheuk Hung Chan To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study Diabetes & Metabolism Journal cohort studies diabetic retinopathy prognosis time-to-treatment vision screening |
| title | To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study |
| title_full | To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study |
| title_fullStr | To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study |
| title_full_unstemmed | To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study |
| title_short | To Determine the Risk-Based Screening Interval for Diabetic Retinopathy: Development and Validation of Risk Algorithm from a Retrospective Cohort Study |
| title_sort | to determine the risk based screening interval for diabetic retinopathy development and validation of risk algorithm from a retrospective cohort study |
| topic | cohort studies diabetic retinopathy prognosis time-to-treatment vision screening |
| url | http://e-dmj.org/upload/pdf/dmj-2024-0142.pdf |
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