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

Objective: To 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. Methods: Simulated 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. Results: Diabetic 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). Conclusions: Increasing 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. Published by Elsevier Ltd.