Prevalence of Diabetic Retinopathy (DR)
VEHSS reports on the prevalence of diabetic retinopathy (DR) for the following categories based on the method of identification:
Examination-Based DR
The 2005-2008 National Health and Nutrition Examination Survey (NHANES) includes identification of DR based on retinal images. VEHSS summarizes the NHANES results, which represent a population-level prevalence estimate of DR defined as having a graded retinopathy level from 14 to 80 based on a modified Early Treatment Diabetic Retinopathy Study (ETDRS) scale in the worse affected eye.
VEHSS also includes summaries of published estimates of DR prevalence from population-based studies.
| Dataset | Description | Variable name(s) | Sample | Response options |
|---|---|---|---|---|
| NHANES | Percentage of people with diabetic retinopathy, based on examination | OPDURET – Retinopathy level, worse eye | Ages 40-150 | 14 – HE, SE, IRMA, VL but no MAS |
| 15 – HEM only, no MAS | ||||
| 20 – MAS only | ||||
| 31 – Early NPR | ||||
| 41 – Moderate NPR | ||||
| 51 – Severe NPR | ||||
| 60 – Fibrous proliferation only | ||||
| 61 – No retinopathy but PRP laser | ||||
| 62 – MAS only + PRP laser | ||||
| 63 – Early NPR + PRP laser | ||||
| 63 – Early NPR + PRP laser | ||||
| 64 – Moderate/severe NPR + PRP laser | ||||
| 65 – PR < HRC | ||||
| 70 – PR >= HRC | ||||
| 80 – Total VH |
Acronym definitions:
HE=hard exudate; SE=soft exudate; IRMA=intraretinal microvascular abnormalities; VL=venous loops; MAS=microaneurysms; HEM=hemorrhages; NPR=nonproliferative retinopathy; RET=retinopathy; PRP LASER=panretinal photocoagulation scars present; PR=proliferative retinopathy; HRC=high-risk characteristics as defined in the Early Treatment Diabetic Retinopathy Study; VH=vitreous hemorrhage.
The data source for this category is National Health and Nutrition Examination Survey (NHANES). See data source documentation.
Self-Reported DR
The National Health Interview Survey (NHIS) and NHANES include self-report questions on whether a doctor ever told the respondent that they had DR. VEHSS summarizes the prevalence of self-reported diagnosed DR, which represents indicators of population prevalence of previously diagnosed DR.
| Dataset | Description | Question Text | Variable name(s) | Sample | Response options |
|---|---|---|---|---|---|
| NHANES | Percentage of people who were ever told by an eye doctor their diabetes affected their eyes | Has a doctor ever told {you/SP} that diabetes has affected {your/his/her} eyes or that {you/s/he} had retinopathy (ret-in-op-ath-ee)? | DIQ080 | Ages 12-150 | 1 – Yes, 2 – No, 7 – Refused, 9 – Don’t know, . – Missin |
| NHIS –Adult module | Percentage of adults ever told by a doctor or other health professional they had diabetic retinopathy | Have you EVER been told by a doctor or other health professional that you had diabetic retinopathy? | VIM_DREV | Ages 18+ | 1 – Yes, 2 – No, 7 – Refused, 9 – Don’t know |
The data source for this category is National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS) – Adult module. See data source documentation.
VEHSS reports the annual prevalence of diagnosed diabetic eye diseases based on the presence of International Classification of Diseases (ICD)-9 and ICD-10 codes in patient claims or electronic health record (EHR) systems. Patients with one or more diagnosis codes associated with a VEHSS subgroup are assigned to that subgroup. Diagnosis codes may be primary or secondary. Only one instance of a diagnosis code is required for assignment to the subgroup. Note that diagnosis codes in claims data are intended for billing purposes and may underrepresent true prevalence. Codes may not be present in cases where diagnosis codes are not required to justify payment. Diagnosed prevalence will also not identify any undiagnosed conditions, will not include patients not covered by the insurer, and will not identify prevalence among patients without a visit in the calendar year of data.
DR, Clinical Subgroups
VEHSS defines the following clinical subgroups. Clinical subgroups are not mutually exclusive.
| Subgroup | Indicated conditions |
|---|---|
| Diagnosed DR – Any Stage | Category total – includes any clinical stage below. |
| Nonsevere, Nonproliferative Diabetic Retinopathy | Early, mild, or moderate diabetic retinopathy includes diagnosis codes for background diabetic retinopathy, mild nonproliferative diabetic retinopathy, or moderate nonproliferative diabetic retinopathy. |
| Severe Nonproliferative Diabetic Retinopathy | Severe nonproliferative diabetic retinopathy includes diagnosis codes indicating severe nonproliferative diabetic retinopathy without macular edema. |
| Proliferative Diabetic Retinopathy | Proliferative diabetic retinopathy includes diagnosis codes indicating proliferative diabetic retinopathy without macular edema. |
| Diabetic Macular Edema (DME | Diabetic macular edema (DME) includes diagnosis codes indicating diabetic retinopathy of any type with the presence of macular edema, including clinically significant diabetic macular edema (CSDME). |
| Other/Unspecified Diabetes-Related Eye Conditions | Other/unspecified diabetes-related eye conditions include diagnosis codes indicating diabetic retinopathy of unspecified type, other ophthalmic complications of diabetes including diabetic cataract, or diabetes mellitus with ophthalmic complication resolved after treatment. |
The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, Managed Vision Care, and MarketScan commercial insurance claims. See data source documentation.
DR by Vision-Threatening Status
VEHSS defines the following summary subgroups indicating vision-threatening or nonvision-threatening DR. These summary groups are mutually exclusive and sum to equal the category total of all patients with diagnosed DR of any stage.
| Subgroup | Indicated conditions |
|---|---|
| Vision-threatening DR | Vision-threatening DR includes severe nonproliferative, proliferative, or diabetic macular edema. |
| Nonvision-threatening DR | Nonvision-threatening DR includes nonproliferative DR or other/unspecified diabetes-related eye conditions and not vision-threatening DR. |
The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, Managed Vision Care, and MarketScan commercial insurance claims. See data source documentation.