Two-stage diagnostic intervals in diabetic retinopathy and associated factors: a cross-sectional study

To characterize two stage-specific diagnostic intervals in diabetic retinopathy (DR) and examine factors associated with each stage. In this cross-sectional study, 283 patients newly diagnosed with DR were enrolled. We evaluated two intervals: Phase 1, from diabetes diagnosis to ocular symptom onset (pre-symptomatic interval), and Phase 2, from symptom onset to first DR diagnosis (symptom-to-diagnosis interval). We grouped Phase 1 as < 10 years versus ≥ 10 years and Phase 2 as ≤ 6 months versus > 6 months. Candidate variables were assessed in univariate analyses and entered into multivariable logistic regression as appropriate. Overall, 62.5% of patients had a Phase 1 interval of ≥ 10 years, and 69.6% received a DR diagnosis within ≤ 6 months after symptom onset (Phase 2). In multivariable analyses, the Phase 1 interval category was independently associated with right-eye logMAR BCVA at diagnosis, HbA1c at diagnosis, DR stage, age at diabetes onset, and occupation. A longer Phase 2 interval (> 6 months) was associated with poorer self-perceived visual function and living with adult children rather than a spouse. Factors associated with the two diagnostic intervals differed across stages, supporting a stage-specific interpretation of the DR diagnostic pathway. Phase 1 was primarily associated with clinical characteristics at diagnosis, whereas Phase 2 was more closely associated with patient-reported visual function and family context. These findings highlight the importance of proactive retinal screening before symptom onset and suggest that optimizing referral pathways and family-supported healthcare seeking may facilitate earlier diagnosis after symptoms emerge.