Impact and Characterization of Delayed Pan-Retinal Photocoagulation in Proliferative Diabetic Retinopathy

PURPOSE: The American Academy of Ophthalmology recommends that patients diagnosed with proliferative diabetic retinopathy (PDR) be considered for panretinal photocoagulation (PRP) treatment within 1 month of diagnosis. This study aimed to investigate the effect delayed treatment had on visual outcomes and to characterize the medical and socioeconomic factors that contributed to delayed treatment of PDR.DESIGN: Retrospective clinical study.METHODS: This study examined 259 patients diagnosed with PDR and treated with PRP from 2015 to the present. Visual acuity (VA) outcomes through 24 months were compared among patients treated the day of diagnosis, and at 1-14 days, 14-31 days, and >31 days post-treatment. The relationships between time to treatment (days between PDR diagnosis and PRP) and medical comorbidities (coronary artery disease and/or myocardial infarction, heart failure, chronic kidney disease, dialysis, stroke, inpatient admission), laboratory values (hemoglobin A1c, blood urea nitrogen, serum creatinine), and socioeconomic factors (health insurance, median household income of ZIP code, and distance from ZIP code to treatment site) were examined.RESULTS: Mean time to treatment for all patients was 27.8 +/- 41.4 days. VA was significantly decreased in patients who received PRP after 31 days compared with those treated on the day of diagnosis at 12 (P <.001) and 24 (P [.03) months post-treatment. Inpatient admission between diagnosis and treatment was significantly associated with an increase in time to treatment (86.5 +/- 50.2 days; P<.001).CONCLUSIONS: In patients with diagnosed PDR, a delay in PRP treatment beyond 31 days was associated with worse visual outcomes than those treated earlier. Hospital admissions significantly delayed PRP delivery. (C) 2020 Published by Elsevier Inc.