Estimated Prevalence of Other Ocular Disease Fundus Photography Findings in Non-Referable Diabetic Retinopathy

Estimated Prevalence of Other Ocular Disease Fundus Photography Findings in Non-Referable Diabetic Retinopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Estimated Prevalence of Other Ocular Disease Fundus Photography Findings in Non-Referable Diabetic Retinopathy Christopher T. Le, Eric W. Lai, Kristen Nwanyanwu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8897131/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : Automated diabetic retinopathy detection has potential benefits but can disrupt referral pathways for discovering notable other ocular disease findings in those with non-referable diabetic retinopathy. This study identifies other ocular disease finding prevalence and associations in patients with non-referable diabetic retinopathy using National Health and Nutrition Examination Survey (NHANES) data. Methods : We conducted a cross-sectional study and analyzed NHANES (2005-2008) data from participants with and without diabetes aged ≥40 years with fundus photos with none or mild retinopathy in their worse eye. Other ocular disease findings were determined based on existing NHANES fundus photo labels for any of 12 selected pathologies. We compared demographic and clinical factors in those with and without other ocular disease findings. Results : In 757 participants with diabetes and non-referable diabetic retinopathy, 44.5% had other ocular disease findings. In 4,053 participants without diabetes, 36.3% had other ocular disease findings (p<0.01). Prevalence of glaucomatous changes and hypertensive changes were more common in those with non-referable diabetic retinopathy compared to participants without diabetes. Participants with other ocular disease findings were more prevalent in older, hypertensive, and insured individuals (all p<0.05). Conclusion : Other ocular fundus abnormalities are frequently present among individuals with diabetes undergoing screening despite having non-referable diabetic retinopathy. These findings underscore the potential risk of missed clinically meaningful pathology if automated diabetic retinopathy detection systems focus solely on retinopathy severity. As autonomous screening expands, broader fundus evaluation strategies may be needed to preserve comprehensive ocular disease detection while maintain efficiency. Diabetic Retinopathy Referable Diabetic Retinopathy Fundus Photography Automated Screening Other ocular disease findings Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8897131","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592768433,"identity":"83d6e441-1a57-4df3-99d4-66ff94d91c89","order_by":0,"name":"Christopher T. 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Lai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYFACxgYGhgIGHn4g6wCUS4wWAwYeSSBFrBYQMACiA8Rq4Zc+3PiBwcBOxvhG8oMDHxhsZDccIKBFsi+xWYLBIJnH7EaawcEZDGnGBLUYnGFsA5LMQC0JBod5GA4nEtRiD9FSz2M8I/3D4T8M/wlrMeABaznMYyCRY3AYGAKEtUicYWyWSDA4ziNx5k3BwR6DZOOZhLTw97A//PChotqevz1944MfFXayfYS0gEECiBAAkQbEKEfYR5Tpo2AUjIJRMBIBACIQQZPXVRl0AAAAAElFTkSuQmCC","orcid":"","institution":"Yale University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Eric","middleName":"W.","lastName":"Lai","suffix":""},{"id":592768435,"identity":"1a494929-c55d-46bf-aa30-44af513862e5","order_by":2,"name":"Kristen Nwanyanwu","email":"","orcid":"","institution":"Yale University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kristen","middleName":"","lastName":"Nwanyanwu","suffix":""}],"badges":[],"createdAt":"2026-02-17 03:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8897131/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8897131/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103506736,"identity":"64a1437e-9ff3-46d9-b01e-96973e3b306f","added_by":"auto","created_at":"2026-02-26 13:39:19","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":765936,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8897131/v1_covered_27a9d29f-0470-43b6-b24a-11a326027a3e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Estimated Prevalence of Other Ocular Disease Fundus Photography Findings in Non-Referable Diabetic Retinopathy","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diabetic Retinopathy, Referable Diabetic Retinopathy, Fundus Photography, Automated Screening, Other ocular disease findings","lastPublishedDoi":"10.21203/rs.3.rs-8897131/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8897131/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Automated diabetic retinopathy detection has potential benefits but can disrupt referral pathways for discovering notable other ocular disease findings in those with non-referable diabetic retinopathy. This study identifies other ocular disease finding prevalence and associations in patients with non-referable diabetic retinopathy using National Health and Nutrition Examination Survey (NHANES) data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We conducted a cross-sectional study and analyzed NHANES (2005-2008) data from participants with and without diabetes aged ≥40 years with fundus photos with none or mild retinopathy in their worse eye. Other ocular disease findings were determined based on existing NHANES fundus photo labels for any of 12 selected pathologies. We compared demographic and clinical factors in those with and without other ocular disease findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: In 757 participants with diabetes and non-referable diabetic retinopathy, 44.5% had other ocular disease findings. In 4,053 participants without diabetes, 36.3% had other ocular disease findings (p\u0026lt;0.01). Prevalence of glaucomatous changes and hypertensive changes were more common in those with non-referable diabetic retinopathy compared to participants without diabetes. Participants with other ocular disease findings were more prevalent in older, hypertensive, and insured individuals (all p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Other ocular fundus abnormalities are frequently present among individuals with diabetes undergoing screening despite having non-referable diabetic retinopathy. These findings underscore the potential risk of missed clinically meaningful pathology if automated diabetic retinopathy detection systems focus solely on retinopathy severity. As autonomous screening expands, broader fundus evaluation strategies may be needed to preserve comprehensive ocular disease detection while maintain efficiency.\u003c/p\u003e","manuscriptTitle":"Estimated Prevalence of Other Ocular Disease Fundus Photography Findings in Non-Referable Diabetic Retinopathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 09:52:31","doi":"10.21203/rs.3.rs-8897131/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c7340c22-3006-480d-a975-5293051811ed","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-24T09:52:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 09:52:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8897131","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8897131","identity":"rs-8897131","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}