To Örebro University

DESIGN: Cross-sectional retrospective cohort study.

PURPOSE: To investigate if quantifying retinal microvascular lesions is a reliable outcome measure in elderly.

METHODS: Fundus photographs from all patients with type 2 diabetes, age ≥80 years, visiting the screening program 2008 in Region Värmland Sweden, n = 668, were reviewed. Inclusion criteria were mild/moderate diabetic retinopathy (DR) according to the International Diabetic Retinopathy Severity Scale. Exclusion criteria were hard exudates within two disc-diameters, and microaneurysms or haemorrhages within one-disc diameter, from the centre of the macula. Two observers counted microaneurysms and haemorrhages independently. Outcome measures were the total sum of microaneurysms and the total sum of haemorrhages per patient. Correlation, agreement and reliability between the counts of the observers was assessed. Analyses microaneurysm counts utilized all included patients while analyses of haemorrhages those with at least moderate DR in one eye.

RESULTS: In total 101 patients met the inclusion/exclusion criteria, median age 82 years and 50.5% were of female sex. Moderate DR in at least one eye was present in 59 patients. In all patients the number of microaneurysms ranged from 1-82, and among patients with at least moderate DR the haemorrhages ranged from 1–29. For microaneurysm count the Pearson correlation coefficient was 0.896 p < 0.001 and intraclass correlation coefficient (ICC) was 0.944 (95% CI 0.917–0.962) between the two observers. For haemorrhage count the Pearson correlation coefficient was 0.897 p < 0.001 and ICC was 0.94 (95% CI: 0.893–0.965) between the two observers.

CONCLUSIONS: Retinal microaneurysm count and haemorrhage count was assessed with excellent reliability. The results suggests that retinal microvascular lesions in elderly with diabetes can be manually quantified but the usefulness of such measures needs further evaluation.