Progression of Diabetic Retinopathy in Wales during the COVID-19 Pandemic

Introduction and Objective: Between March and September 2020, routine healthcare in the UK, including diabetic retinopathy (DR) screening, was paused due to the COVID-19 pandemic. This created a natural experiment to explore the impact of extended screening intervals. Methods: Data from Diabetic Eye Screening Wales (DESW) and primary care were linked using the Secure Anonymised Information Linkage databank (SAIL). Individuals screened within 12 months pre-lockdown and rescreened between March 2020 and August 2022 were included. Results: Of 12,424 individuals with no DR pre-lockdown, 84.3% remained free of retinopathy post-lockdown, 15.8% progressed to background retinopathy, and 0.3% to referable retinopathy. Background Retinopathy (Pre-Lockdown): Of 11,694 individuals with background DR pre-lockdown, 30.8% regressed to no retinopathy, 64.9% remained with background DR, and 4.4% progressed to referable diabetic retinopathy (RDR). Of 731 individuals with RDR pre-lockdown, 3.3% had no DR post-lockdown, 36.0% regressed to background DR, and 60.7% remained at referable level. Of 24,866 individuals with no maculopathy pre-lockdown, 94% remained maculopathy-free, while 6.0% developed diabetic maculopathy. Diabetic Of 257 individuals with diabetic maculopathy pre-lockdown, 50.6% regressed to no maculopathy, while 49.4% remained unchanged. Conclusion: The risk of progression from no DR to RDR or maculopathy was low (0.3% and 6.0%, respectively). Only 10% of those referred with suggested maculopathy required treatment. This study provides further evidence that screening biennially is considered safe for those without DR Disclosure: R.L. Thomas: None. W. Cheung: None. J. Rafferty: None. L. Pratt: None. J. Cherry: None. R. Reynolds: None. G. Williams: None. S.C. Bain: Research Support; Novo Nordisk A/S, Lilly Diabetes. Speaker's Bureau; Menarini, AstraZeneca. Research Support; Boehringer-Ingelheim, Abbott Diagnostics, Amgen Inc. D.R. Owens: None. Funding: Health and Care Research Wales (HRG-20-1776(P))