Diabetic Retinopathy (DR)

What to know

VEHSS reports on the prevalence of diabetic retinopathy (DR) for the following categories based on these methods 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.

Explore Data in the VEHSS Application‎

The data source for this category is National Health and Nutrition Examination Survey (NHANES).

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.

Subgroup

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

Explore Data in the VEHSS Application‎

The data source for this category is National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS) – Adult module.

Diagnosed DR

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.

Explore Data in the VEHSS Application‎

The data sources available for this category include Medicare (default), IRIS Registry, Medicaid, Managed Vision Care, and MarketScan commercial insurance claims.

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.

Keep Reading: Explore VEHSS Data