scholarly journals The contribution of the English NHS Diabetic Eye Screening Programme to reductions in diabetes-related blindness, comparisons within Europe, and future challenges

2021 ◽  
Vol 58 (4) ◽  
pp. 521-530
Author(s):  
Peter. H. Scanlon
Keyword(s):  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Disease Process ◽  
Diabetic Macular Oedema ◽  
Automated Analysis ◽  
Risk Groups ◽  
Pressure Control ◽  
Eye Screening ◽  
Future Challenges ◽  
Diabetic Eye Screening

AbstractThe aim of the English NHS Diabetic Eye Screening Programme (DESP) is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process, with a long-term aim of preventing blindness in people with diabetes.For the year 2009–2010, diabetic retinopathy (DR) was no longer the leading cause of blindness in the working age group. There have been further reductions in DR certifications for WHO severe vision impairment and blindness from 1,334 (5.5% of all certifications) in 2009/2010 to 840 (3.5% of all certifications) in 2018/2019. NHS DESP is a major contributor to this further reduction, but one must also take into account improvements in glycaemic and blood pressure control, timely laser treatment and vitrectomy surgery, improved monitoring techniques for glycaemic control, and vascular endothelial growth factor inhibitor injections for control of diabetic macular oedema. The latter have had a particular impact since first introduced in the UK in 2013.Current plans for NHS DESP include extension of screening intervals in low-risk groups and the introduction of optical coherence tomography as a second line of screening for those with screen positive maculopathy with two dimensional markers. Future challenges include the introduction of automated analysis for grading and new camera technologies.

scholarly journals Can Commercially Available Handheld Retinal Cameras Effectively Screen Diabetic Retinopathy?

2016 ◽  
Vol 11 (1) ◽  
pp. 135-137 ◽  
Author(s):  
Jorge Cuadros ◽  
George Bresnick
Keyword(s):  
Clinical Trials ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Low Cost ◽  
Clinical Results ◽  
Diabetic Retinopathy Screening ◽  
The United Kingdom ◽  
Eye Screening ◽  
Diabetic Eye Screening ◽  
Retinopathy Screening

Organizations that care for people with diabetes have increasingly adopted telemedicine-based diabetic retinopathy screening (TMDRS) as a way to increase adherence to recommended retinal exams. Recently, handheld retinal cameras have emerged as a low-cost, lightweight alternative to traditional bulky tabletop retinal cameras. Few published clinical trials have been performed on handheld retinal cameras. Peer-reviewed articles about commercially available handheld retinal cameras have concluded that they are a usable alternative for TMDRS, however, the clinical results presented in these articles do not meet criteria published by the United Kingdom Diabetic Eye Screening Programme and the American Academy of Ophthalmology. The future will likely remedy the shortcomings of currently available handheld retinal cameras, and will create more opportunities for preventing diabetic blindness.

scholarly journals Diagnostic accuracy of diabetic retinopathy grading by an artificial intelligence-enabled algorithm compared with a human standard for wide-field true-colour confocal scanning and standard digital retinal images

2020 ◽  
pp. bjophthalmol-2019-315394
Author(s):  
Abraham Olvera-Barrios ◽  
Tjebo FC Heeren ◽  
Konstantinos Balaskas ◽  
Ryan Chambers ◽  
Louis Bolter ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Proliferative Retinopathy ◽  
Retinal Images ◽  
Wide Field ◽  
Diabetic Retinopathy Screening ◽  
Eye Screening ◽  
Confocal Scanning ◽  
Diabetic Eye Screening ◽  
Retinopathy Screening

BackgroundPhotographic diabetic retinopathy screening requires labour-intensive grading of retinal images by humans. Automated retinal image analysis software (ARIAS) could provide an alternative to human grading. We compare the performance of an ARIAS using true-colour, wide-field confocal scanning images and standard fundus images in the English National Diabetic Eye Screening Programme (NDESP) against human grading.MethodsCross-sectional study with consecutive recruitment of patients attending annual diabetic eye screening. Imaging with mydriasis was performed (two-field protocol) with the EIDON platform (CenterVue, Padua, Italy) and standard NDESP cameras. Human grading was carried out according to NDESP protocol. Images were processed by EyeArt V.2.1.0 (Eyenuk Inc, Woodland Hills, California). The reference standard for analysis was the human grade of standard NDESP images.ResultsWe included 1257 patients. Sensitivity estimates for retinopathy grades were: EIDON images; 92.27% (95% CI: 88.43% to 94.69%) for any retinopathy, 99% (95% CI: 95.35% to 100%) for vision-threatening retinopathy and 100% (95% CI: 61% to 100%) for proliferative retinopathy. For NDESP images: 92.26% (95% CI: 88.37% to 94.69%) for any retinopathy, 100% (95% CI: 99.53% to 100%) for vision-threatening retinopathy and 100% (95% CI: 61% to 100%) for proliferative retinopathy. One case of vision-threatening retinopathy (R1M1) was missed by the EyeArt when analysing the EIDON images, but identified by the human graders. The EyeArt identified all cases of vision-threatening retinopathy in the standard images.ConclusionEyeArt identified diabetic retinopathy in EIDON images with similar sensitivity to standard images in a large-scale screening programme, exceeding the sensitivity threshold recommended for a screening test. Further work to optimise the identification of ‘no retinopathy’ and to understand the differential lesion detection in the two imaging systems would enhance the use of these two innovative technologies in a diabetic retinopathy screening setting.

The screening episode: visual acuity, mydriasis, and digital photography

2020 ◽  
pp. 89-100
Author(s):  
David K. Roy ◽  
Prashant Amrelia
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Chronic Disease ◽  
Image Quality ◽  
Early Detection ◽  
Subsequent Treatment ◽  
Diabetic Patients ◽  
Eye Screening ◽  
Diabetic Eye Screening ◽  
Acceptable Image Quality

Early eye screening detection and treatment is fundamental in managing significant complications of chronic disease, both for improving diabetic retinopathy (DR) clinical outcomes and improving the economic burdens. Early detection and subsequent treatment can substantially reduce the risk of blindness from DR. This chapter will review the screening episode, measuring visual acuity, drop instillation, contraindications, and correct camera operation. It will review problems associated with incorrect camera operation and the NHS Diabetic Eye Screening Programme (NHSDESP) standards of acceptable image quality. This will guide the screener in obtaining clear, well-centred, gradable digital images of the retina in diabetic patients with vision better than no perception of light in both eyes, as well as providing a greater understanding of issues associated with screening.

scholarly journals A classification model for predicting diabetic retinopathy based on patient characteristics and biochemical measures

2017 ◽  
Vol 1 (4) ◽  
pp. 69-85
Author(s):  
Evangelia Kotsiliti ◽  
Bashir Al-Diri ◽  
Andrew Hunter
Keyword(s):  
At Risk ◽  
Diabetic Retinopathy ◽  
Random Forest ◽  
Screening Program ◽  
Patient Characteristics ◽  
Gradient Boosting ◽  
Eye Screening ◽  
Gradient Boosting Machine ◽  
Patients At Risk ◽  
Diabetic Eye Screening

  Purpose: In the United Kingdom (UK), The NHS Diabetic Eye Screening Program offers an annual eye examination to all people with diabetes aged 12 or over, aiming at the early detection of people at high risk of visual loss due to diabetic retinopathy. The purpose of this study was the design of a model to predict patients at risk of developing retinopathy with the use of patient characteristics and clinical measures. Methods: We investigated data from 2011 to 2016 from the population-based Diabetic Eye Screening Program in East Anglia. The data comprised retinal eye screening results, patient characteristics, and routine biochemical measures of HbA1c, blood pressure, Albumin to Creatinine ratio (ACR), estimated Glomerular Filtration rate (eGFR), serum creatinine, cholesterol and Body Mass Index (BMI). Individuals were classified according to the presence or absence of retinopathy as indicated by their retinal eye examinations. A lasso regression, random forest, gradient boosting machine and regularized gradient boosting model were built and cross-validated for their predictive ability.  Results: A total of 6,375 subjects with recorded information for all available biochemical measures were identified from the cohorts. Of these, 5,969 individuals had no signs of diabetic retinopathy. Of the remainder 406 individuals with signs of diabetic retinopathy, 352 had background diabetic retinopathy and 54 had referable diabetic retinopathy. The highest value of the10-fold cross-validated Area under the Curve (AUC) was achieved by the gradient boosting machine 0.73 ± 0.03 and the minimum required set of variables to yield this performance included 4 variables: duration of diabetes, HbA1c, ACR and age. A subsequent analysis on the predictive power of the biochemical measures showed that when HbA1c and ACR measurements were available for longer time periods, the performance of the models was greatly enhanced. When HbA1c and ACR measurements for a 5-year period prior to the event of study were available, gradient boosting machine cross-validated AUC was 0.77 ± 0.04 in comparison to the cross-validated AUC of 0.68 ± 0.04 when only information for the 1-year period for these variables was available. Similarly, an increment from 0.70 ± 0.02 to 0.75 ± 0.04 was observed with random forest. The dataset with the 1-year measurements comprised 4,857 subjects, of whom, 4,572 had no retinopathy and the remainder 285 had signs of retinopathy. The dataset with the 5-year measurements comprised 757 subjects, of whom, 696 had no retinopathy and the remainder 51 had signs of retinopathy. Conclusions: The utilization of patient information and routine biochemical measures can be used to identify patients at risk of developing retinopathy. The effective differentiation between patients with and without retinopathy could significantly reduce the number of screening visits without compromising patients’ health. 

scholarly journals Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

2021 ◽  
Vol 9 (2) ◽  
pp. e002436
Author(s):  
Louise Prothero ◽  
Fabianna Lorencatto ◽  
Martin Cartwright ◽  
Jennifer M Burr ◽  
Philip Gardner ◽  
...  
Keyword(s):  
Young Adults ◽  
Screening Programme ◽  
Perceived Barriers ◽  
Self Management ◽  
Screening Uptake ◽  
Diabetic Retinopathy Screening ◽  
Eye Screening ◽  
Diabetic Eye Screening ◽  
The Uk ◽  
Retinopathy Screening

IntroductionDiabetic retinopathy screening (DRS) attendance in young adults is consistently below recommended levels. The aim of this study was to conduct a survey of screening providers in the UK Diabetic Eye Screening Programme (DESP) to identify perceived barriers and enablers to DRS attendance in young adults and elicit views on the effectiveness of strategies to improve screening uptake in this population.Research design and methodsMembers of the British Association of Retinal Screening (n=580) were invited to complete an anonymous online survey in July 2020 assessing agreement with 37 belief statements, informed by the Theoretical Domains Framework (TDF) of behavior change, describing potential barrier/enablers to delivering DRS for young adults and further survey items exploring effectiveness of strategies to improve uptake of DRS.ResultsIn total, 140 (24%) responses were received mostly from screener/graders (67.1%). There was a high level of agreement that the DESP had a role in improving attendance in young adults (96.4%) and that more could be done to improve attendance (90.0%). The most commonly reported barriers related to TDF domains Social influences and Environmental context and resources including lack of integration of DRS with other processes of diabetes care, which limited the ability to discuss diabetes self-management. Other barriers included access to screening services and difficulties with scheduling appointments. Less than half (46.4%) of respondents reported having a dedicated strategy to improve screening uptake in young adults. Strategies perceived to be effective included: screening within the community; prompts/reminders and integrating eye screening with other diabetes services.ConclusionsScreening providers were concerned about screening uptake in young adults, although many programs lacked a dedicated strategy to improve attendance. Problems associated with a lack of integration between DRS with other diabetes care processes were identified as a major barrier to providing holistic care to young adults and supporting diabetes self-management.

Advanced diabetic eye disease

2020 ◽  
pp. 63-70
Author(s):  
Karen Whitehouse
Keyword(s):  
Diabetic Retinopathy ◽  
Subsequent Treatment ◽  
Eye Disease ◽  
Diabetic Retinopathy Screening ◽  
Eye Screening ◽  
Slow Progression ◽  
Long Time ◽  
Diabetic Eye Disease ◽  
Proliferative Disease ◽  
Diabetic Eye Screening

Advanced diabetic eye disease can remain asymptomatic for a long time, due to the slow progression of proliferative retinopathy and the fact that the macula may not be affected. This chapter examines the progression of proliferative disease and its’ natural history if left untreated. Diabetic retinopathy screening is an important factor in intervention and treatment. The grading criteria for advanced disease (R3) as defined by the NHS Diabetic Eye screening Programme (NHSDESP) is discussed, as well as the management of the patient and subsequent treatment regimen.

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Diabetologia ◽  
2013 ◽  
Vol 56 (10) ◽  
pp. 2187-2193 ◽  
Author(s):  
Alice S. Forster ◽  
Angus Forbes ◽  
Hiten Dodhia ◽  
Clare Connor ◽  
Alain Du Chemin ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Population Based ◽  
Eye Screening ◽  
Diabetic Eye Screening

An Optical Practice Based Diabetic Eye Screening Programme

1995 ◽  
Vol 12 (6) ◽  
pp. 531-536 ◽  
Author(s):  
W. Gatling ◽  
A.J. Howie ◽  
R.D. Hill
Keyword(s):  
Screening Programme ◽  
Eye Screening ◽  
Diabetic Eye Screening
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