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Sensitivity of diabetic retinopathy associated vision loss to screening interval in an agent-based/discrete event simulation model

Authors
  • Day, T. Eugene
  • Ravi, Nathan
  • Xian, Hong
  • Brugh, Ann1, 2
  • 1 VA St. Louis Healthcare System
  • 2 Washington University in St. Louis School of Medicine
Type
Published Article
Journal
Computers in Biology and Medicine
Publication Date
Jan 01, 2014
Accepted Date
Jan 14, 2014
Volume
47
Pages
7–12
Identifiers
DOI: 10.1371/journal.pone.0066812
Source
Elsevier
Keywords
License
Unknown

Abstract

ObjectiveTo examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk. MethodsSimulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans – using abstracted data from a retrospective cohort of real-world diabetic Veterans – with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group. ResultsDiabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98). ConclusionsIncreasing the screening interval for diabetic patients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss.

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