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Comput Biol Med. 2014 Apr;47:7-12. doi: 10.1016/j.compbiomed.2014.01.007. Epub 2014 Jan 21.

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

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VA St. Louis Healthcare System, USA. Electronic address:
VA St. Louis Healthcare System, USA; Washington University in St. Louis School of Medicine, USA.
VA St. Louis Healthcare System, USA; St. Louis University School of Public Health, USA.
VA St. Louis Healthcare System, USA.



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.


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.


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).


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.


Agent based modeling; Diabetic eye screen; Diabetic retinopathy; Discrete event simulation

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