Prevalence and Progression of Diabetic Retinopathy in a Tertiary Care Setting: An Initial Review With Recommended Screening Protocols

Introduction: The objective of this study is to evaluate diabetic patients with either normal fundus or non- proliferative diabetic retinopathy (NPDR) changes, examine retinal alterations during follow-up, and propose follow-up guidelines within a tertiary eye care setting. Methods: A five-year prospective longitudinal study is being conducted at the Diabetic Clinic of Al Ibrahim Eye Hospital/Isra Postgraduate Institute of Ophthalmology, Karachi. Induction for the research took place from October 2021 to March 2022, and a two-year preliminary report is presented here. Newly diagnosed type II diabetic patients with normal fundus or NPDR of any stage, irrespective of age, gender, or glycemic status, who were willing to participate and agreed to follow-ups, were included. Patients with proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), fundus non-visibility, or systemic complications of diabetes were excluded. Results: A total of 251 patients were enrolled, consisting of 80 individuals with a normal fundus and 171 with different stages of NPDR, including mild (N=59), moderate (N=91), and severe (N=21) retinopathy. The incidence of progression from mild to moderate NPDR was noted to be 52.5%, with a median time of 3.5 months. Progression from moderate to severe NPDR occurred in 37.1% of cases, with a median time of 4.5 months. Similarly, DME developed in 5% of patients with mild NPDR over eight months, in 22.2% with moderate NPDR over seven months, and in 37.5% with severe NPDR over 4.4 months. Conclusion: This study emphasizes the urgent need to revise diabetic retinopathy (DR) monitoring protocols for our Pakistani (Southeast Asian) population. The rapid progression of NPDR and the high rates of DME development demand more frequent screenings. Current guidelines recommending annual screenings are inadequate. Biannual screenings for patients with a normal fundus or mild NPDR, and quarterly assessments for those with moderate or severe NPDR, are necessary.