Retinal screening for diabetic retinopathy

• Screening optometists in Birmingham...pdf list
• Meeting 2007
• Links
• Papers
• Notes
• Screening cameras in Birmingham
• Iceland...no new blindness from retinopathy

 

 

Meeting

• Diabetic Retinopathy Meeting Liverpool, 28th November 2007.

  The meeting follows on from the "Screening for Diabetic Retinopathy in Europe" meeting in Liverpool in 2005 and is part of the implementation strategy set by the NSF in Diabetes and the National Screening Committee. The meeting is aimed at diabetologists/endocrinologists and ophthalmologists but is also open to colleagues from throughout UK with an interest in diabetes, diabetic retinopathy and screening. The maximum number of places will be 250. Invitations have already been sent to Screening Programmes via Programme Managers and we are now opening to general registration. It would be helpful if you could indicate which screening programme if any you are associated with as we are hoping to have a reasonable geographical spread around the UK. The annual meeting of the Medical Ophthalmology Society of the UK takes place in the same venue on the following day and so many colleagues may wish to stay for both. Contact Email L.Gee at liverpool.ac.uk

Links

• The National Screening Programme for Sight-Threatening Diabetic Retinopathy and the
• British Association for Retinal Screeners websites are the main portals for screening in the UK
• Screener training: contact support@nscretinopathy.org.uk . 
• There is a registration body for screeners.BARS

Papers

• Grading
• a paper by Hulme on slit lamp screening
• a paper indicating the incidence of retinopathy and screening intervals in screening programs
• a search for many useful papers.
• screening effectiveness.
• Computerised analysis of retinal photographs can be very helpful, with a search here.
• http://www.diabetic-retinopathy.screening.nhs.uk/recommendations.html
• For a comprehensive review, see Screening and Monitoring Diabetic Retinopathy (1999)
• screening is erratic, Millett & Dodhia, 2006.
• Pupils should be dilated for accurate screening...this is still debated but is recommended in the UK and many other places
• Examination is more accurate using red-free digital photos
• Grading
• Effectiveness of screening in preventing blindness due to diabetic retinopathy
  C. S. Arun, N. Ngugi, L. Lovelock and R. Taylor
  Professor Taylor's team describe exceptionally low rates of blindness, similar to the best results elsewhere. In a personal communication he states 'Blindness rates must have fallen because of good blood pressure and blood glucose control' .. 'However, I would estimate that 70% of the [improvement] in younger people is as a result of screening, and perhaps 50% in older people'.
• Diabetic retinopathy screening using digital non-mydriatic fundus photography and automated image analysis
• Effective and accurate screening for diabetic retinopathy using a 60 degree mydriatic fundus camera
• Comparison of a digital retinal imaging system and seven-field stereo color fundus photography to detect diabetic retinopathy in the primary care environment.
• Telephone Intervention to Promote Diabetic Retinopathy Screening Among the Urban Poor
• Screening for diabetic retinopathy in primary care with a mobile fundal camera--evaluation of a South African pilot project.
• The role of haemorrhage and exudate detection in automated grading of diabetic retinopathy BJO 2010
• Costs and consequences of automated algorithms versus manual grading for the detection of referable diabetic retinopathy BJO 2010
• Automated grading BJO 2010 "Manual grading workload reduction would be 36.3%".
• OCT might be helpful 2011
• risk of angle closure glaucoma, very low risk. RCO 2011
• can detect wet ARMD. RCO 2011

Notes

• The Birmingham screening program is now underway, and findings are similar to programs elsewhere in the UK.
• Of those screened and graded, 60% have no retinopathy, 35% have background retinopathy, 5% have sight-threatening proliferaton or maculopathy. About 5% of photos are ungradable to to media opacities such as cataracts.
• It is not known how many people do not get screened..but this may be a serious problem.
• most of the hospital appointments are within targets set, as are the laser appointments, but figures should be improved..
• fantastic results have been achieved in Iceland...and there is no reason why they should not be achieved in the UK
• there are 105 UK screening programs...each program may have many cameras dotted around the community
• compliance in screening is directly related to prognosis...those who do not attend screening have the worst visual outcome (Stefansson).
• Biennial eye screening in patients with diabetes without retinopathy: 10-year experience.  Stephanson recommends secreening every 2 years, or even less based on the risk of retinopathy. You can work out your risk.
• In Sheffield, with about 0.5m patients, 115 patients are seen in retinopathy clinics, with 3 laser clinics each week.
• many people do not attend appointments...reasons include awareness of the importance, severity of their problem (percieved an not severe), fear, expecting a cure and there is not one, guilt, work, multiple appointments
• phone call reminders increase attendance, but are not always effective.
• automated (computer software) retinal photo analysis is effective
• Analysis of a comprehensive diabetic retinopathy screening model for rural and urban diabetics in developing countries