Toward an Era of Oculomics

Purpose To assess whether baseline diabetic retinopathy (DR) severity is associated with mortality after adjustment for nonclinical and clinical factors. Design Retrospective cohort study. Participants Five hundred twenty-four thousand six hundred eighty-seven patients with diabetes mellitus (DM) receiving care at health systems in the Collaborative (SOURCE), 2010-2023. Methods Electronic health record data of patients with DM were linked to mortality data from the National Death Index. Patients were categorized at their initial eye care visit into 6 groups based on the level of DR in the more affected eye: DM without DR, nonproliferative DR (NPDR) without diabetic macular edema (DME), NPDR with DME, proliferative DR (PDR) without DME, PDR with DME, and unspecified DR severity. Cox regression modeling assessed the hazard of mortality associated with baseline DR severity, with adjustment for nonclinical and clinical variables (e.g., glycosylated hemoglobin level). Main Outcome Measures Hazard of mortality with 95% confidence intervals (CIs). Results The mean ± standard deviation (SD) age was 59.1 ± 16 years; 283 465 patients (54.0%) were female, 95 160 patients (18.1%) Black, 66 547 patients (12.7%) Latinx, 306 104 (58.3%) White. A total of 36 674 patients (7.0%) died over a mean ± SD of 5.4 ± 4.1 years' follow-up. After adjustment for potential confounders, compared with patients with DM without DR, the hazard for death was increased by 34% in patients with NPDR without DME (hazard ratio [HR], 1.34; 95% CI, 1.29–1.39), 31% in those with NPDR with DME (HR, 1.31; 95% CI, 1.20–1.43), 128% in those with PDR without DME (HR, 2.28; 95% CI, 2.17–2.39), and 87% in those with PDR and DME (HR, 1.87; 95% CI, 1.72–2.05). Older age, male sex, and less affluent residence also were associated with increased hazard of death ( P < 0.01 for all). Conclusions Patients with NPDR or PDR with or without DME were at higher risk for death over an average of 5 years' follow-up, relative to patients with diabetes without DR. These associations remained after adjustment for potential confounders. Eye care professionals should be strongly encouraged to communicate DR severity to other medical professionals, as this may serve as an important opportunity to identify and address patients’ medical comorbidities that may increase their mortality risk. Financial Disclosure(s) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.