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. 2025 Jun;39(9):1710-1716.
doi: 10.1038/s41433-025-03725-1. Epub 2025 Feb 28.

Predicting the need for diabetic macular oedema treatment from photographic screening in the Singapore Integrated Diabetic Retinopathy Programme (SiDRP)

Stanley S J Poh  1 , Kelvin Y C Teo  2 , Rose Ann Goh  3 , Qian Xin Lee  3 , Haslina Hamzah  3 , Serene S C Sim  3 , Colin S Tan  4   5 , Ngiap Chuan Tan  6 , Tien Yin Wong  1   2   4   7   8 , Gavin S W Tan  9   10   11   12
Affiliations

Predicting the need for diabetic macular oedema treatment from photographic screening in the Singapore Integrated Diabetic Retinopathy Programme (SiDRP)

Stanley S J Poh et al. Eye (Lond). 2025 Jun.

Abstract

Objective: To identify diabetic maculopathy features from photographic screening that are predictive of treatment on referral to a tertiary care centre.

Methods: Retrospective review of participants who underwent screening by Singapore Integrated Diabetic Retinopathy Programme from 2015 to 2019. Participants underwent visual acuity (VA) test and non-stereoscopic retinal photographs. Maculopathy features include haemorrhages, microaneurysm and hard exudates (HE), stratified by inner and outer zone (1 and 1-2 disc diameter from fovea respectively) and VA of 6/12. Diabetic macular oedema (DMO) treatment was defined as intravitreal injection or macular photocoagulation up to 540 days from point of referral.

Results: 16,712 patients screened had referable eye disease. Out of 3518 maculopathy suspects, 281 (8.0%) received DMO treatment within 540 days. Those treated for DMO had shorter duration of diabetes (6.90 vs. 9.13 years, p < 0.001), higher total cholesterol (4.65 ± 1.20 vs. 4.36 ± 1.13 mmol/L, p = 0.001) and LDL cholesterol (2.59 ± 1.05 vs. 2.37 ± 0.93 mmol/L, p < 0.05) than those without treatment. High-risk features, including inner zone haemorrhages with VA ≤ 6/12 (HR 12.0, 95% CI: 5.5-25.9) and inner zone hard exudates (HR 7.4, 95% CI: 3.4-15.8), significantly increased the likelihood of requiring DMO treatment compared to low-risk features. Higher body mass index is protective of DMO treatment in mild non-proliferative diabetic retinopathy (HR 0.84, 95% CI: 0.73-0.97).

Conclusion: Haemorrhages, microaneurysms and HE within inner zone are important photographic features predictive of DMO treatment. VA is an important stratification for screening especially in patients with only visible haemorrhages.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart illustrating diabetic maculopathy and non-maculopathy suspects who were screened in the Singapore Integrated Diabetic Retinopathy Programme and subsequently referred to Singapore National Eye Centre (SNEC).
Fig. 2
Fig. 2
Kaplan-Meier Curve of Time from Referral to Diabetic Macular Oedema Treatment.
See this image and copyright information in PMC

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