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Diabetic Retinopathy Screening Programme (diabetic + retinopathy_screening_programme)
Selected AbstractsTrends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programmeDIABETIC MEDICINE, Issue 10 2009A. Misra Abstract Aims, To describe changes in risk profiles and yield in a screening programme and to investigate relationships between retinopathy prevalence, screening interval and risk factors. Methods, We analysed a population of predominantly Type 2 diabetic patients, managed in general practice, and screened between 1990 and 2006, with up to 17 years' follow-up and up to 14 screening episodes each. We investigated associations between referable or sight-threatening diabetic retinopathy (STDR), screening interval and frequency of repeated screening, whilst adjusting for age, duration and treatment of diabetes, hypertension treatment and period. Results, Of 63 622 screening episodes among 20 788 people, 16 094 (25%) identified any retinopathy, 3136 (4.9%) identified referable retinopathy and 384 (0.60%) identified STDR. The prevalence of screening-detected STDR decreased by 91%, from 1.7% in 1991,1993 to 0.16% in 2006. The prevalence of referable retinopathy increased from 2.0% in 1991,1993 to 6.7% in 1998,2001, then decreased to 4.7% in 2006. Compared with screening intervals of 12,18 months, screening intervals of 19,24 months were not associated with increased risk of referable retinopathy [adjusted odds ratio 0.93, 94% confidence interval (CI) 0.82,1.05], but screening intervals of more than 24 months were associated with increased risk (odds ratio 1.56, 95% CI 1.41,1.75). Screening intervals of < 12 months were associated with high risks of referable retinopathy and STDR. Conclusions, Over time the risk of late diagnosis of STDR decreased, possibly attributable to earlier diagnosis of less severe retinopathy, decreasing risk factors and systematic screening. Screening intervals of up to 24 months should be considered for lower risk patients. [source] Interobserver agreement between primary graders and an expert grader in the Bristol and Weston diabetic retinopathy screening programme: a quality assurance auditDIABETIC MEDICINE, Issue 8 2009S. Patra Abstract Aims, To assess the quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and to set standards for future interobserver agreement reports. Methods, A prospective audit of 213 image sets from six fully trained primary graders in the Bristol and Weston diabetic retinopathy screening programme was carried out over a 4-week period. All the images graded by the primary graders were regraded by an expert grader blinded to the primary grading results and the identity of the primary grader. The interobserver agreement between primary graders and the blinded expert grader and the corresponding Kappa coefficient was determined for overall grading, referable, non-referable and ungradable disease. The audit standard was set at 80% for interobserver agreement with a Kappa coefficient of 0.7. Results, The interobserver agreement bettered the audit standard of 80% in all the categories. The Kappa coefficient was substantial (0.7) for the overall grading results and ranged from moderate to substantial (0.59,0.65) for referable, non-referable and ungradable disease categories. The main recommendation of the audit was to provide refresher training for the primary graders with focus on ungradable disease. Conclusion, The audit demonstrated an acceptable level of quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and provided a standard against which future interobserver agreement can be measured for quality assurance within a screening programme. [source] Use of oral fluorescein angiography in the diagnosis of macular oedema within a diabetic retinopathy screening programmeDIABETIC MEDICINE, Issue 12 2001F. M. Razvi Abstract Aims To assess if oral fluorescein angiography (OFA) is a suitable screening method to detect macular oedema in diabetic retinopathy. Methods Eighty-four diabetic patients were included in the study. They were from a consecutive series of patients attending the diabetic eye-screening clinic, with retinopathy at the macula requiring ophthalmology assessment. All patients were subsequently examined in the eye hospital, by ophthalmologist slit lamp biomicroscopy assessment as the gold standard, followed by oral fluorescein angiography. Results This study indicates a sensitivity of 92% and specificity of 81%. Only 4.8% of patients developed a minor reaction to oral fluorescein; 84.5% of images were of good quality. Conclusions Oral fluorescein angiography is an efficient and highly sensitive tool for the detection of macular oedema. It can be used as an adjunct in the diabetic screening service to identify patients with oedema within a disc diameter of the macula. Ultimately it will ensure that only necessary and smaller numbers of patients are referred to ophthalmologists. Diabet. Med. 18, 1003,1006 (2001) [source] Screening history in those requiring fast track referral for proliferative diabetic retinopathy (PDR) in the ni diabetic retinopathy screening programmeACTA OPHTHALMOLOGICA, Issue 2009PM HART Purpose If PDR is detected at screening, an urgent referral to an ophthalmologist ensues. This outcome can be stressful for patients and for the ophthalmologists who may need to treat very quickly. Aim: To examine the screening history of those deemed to require an urgent referral, with a view to identifying missed cases of referable diabetic retinopathy in previous screening encounters; and risk factors for interval cases. Methods Fast tracked urgent referrals were identified from the NI DRSP database. Demographic factors and previous screening history were analysed. Results In 2006-7 18,887 attended for screening. 5.6% required referral to an eye clinic of which 0.3% were deemed urgent referrals (52 cases) 47 showed PDR; 5 had advanced NPDR in an only eye. 47% had Type 1 Diabetes; 52% had been diabetic for 20 years or more; 8% had been diabetic for 5 years or less. On feedback 98% were found to be appropriate referrals. At time of screening, 6 people had been lost to follow up from previous eye clinics. PDR was identified at the first screening event in the other 46 (88%). No cases were found where referral at a previous screening encounter would have been appropriate. Conclusion Especially during the early years, screening programmes are very likely to encounter sight threatening retinopathy not previously identified. Over time, the balance between referral early in the disease process, and late, will hopefully be achieved but until then clinics must be prepared to manage the unpredictable urgent referral. 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