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

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.