Potential impact of fluorescein angiography as a primary imaging modality in the management of diabetic retinopathy

• Published in: Indian journal of ophthalmology 2022-10, Vol.70 (10), p.3579-3583
• Main Authors: Ashraf, Mohamed, Wagdy, Walaa, Tawfik, Mohamed, Ahmed, Islam, Souka, Ahmed
• Format: Article
• Language: English
• Subjects: Angiography; Care and treatment; Cross-Sectional Studies; Diabetes; Diabetes Mellitus; Diabetic Retinopathy; Disease management; Edema; egypt; Evaluation; Fluorescein; fluorescein angiography; Fluorescein Angiography - methods; Humans; Macular Edema - diagnosis; Macular Edema - etiology; Macular Edema - pathology; Medical imaging; Medical personnel; Original; Patient outcomes; Patients; practice patterns; Retinopathy; survey; Tomography, Optical Coherence - methods
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_641_22

Purpose: To evaluate current practice patterns for Egyptian ophthalmologists in the diagnosis of diabetic retinopathy (DR) and explore potential implications of these approaches on management. Methods: Cross-sectional survey conducted in Egypt amongst practicing ophthalmologists. Results: The study had 203 responses (~6% of all Egyptian ophthalmologists). A majority of respondents were general ophthalmologists (78.2%), practicing for five to ten years (41.9%). In patients with DR and no diabetic macular edema (DME), 33.0% of respondents would use FA in patients with mild DR, 44.3% in patients with moderate DR and 51.2% in patients with severe non-proliferative diabetic retinopathy (NPDR). Color imaging (CI) was used by less than 1% as the sole imaging modality for any level of DR. Approximately 70% of respondents used fluorescein angiography (FA) to grade and base treatment decisions for DR, either alone or in conjunction with dilated eye exams and/or CI. Given the known more severe appearance of DR on FA than on standard color imaging upon which treatment guidelines are based, use of FA as the primary modality over a one-year period could result in PRP that would otherwise not be suggested in approximately 78,820 eyes at an additional cost of $10.1 million US dollars. These numbers are projected to double by 2045. Conclusion: Given that FA detects significantly greater pathology than CI, and that treatment and follow-up recommendations are based on CI, its use as the primary imaging modality in DR grading may result in apparently significantly higher DR severity, with subsequently increased procedures and associated costs.