Trends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programme

2009 ◽  
Vol 26 (10) ◽  
pp. 1040-1047 ◽  
Author(s):  
A. Misra ◽  
M. O. Bachmann ◽  
R. H. Greenwood ◽  
C. Jenkins ◽  
A. Shaw ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Community Based ◽  
Diabetic Retinopathy Screening ◽  
Screening Intervals ◽  
Retinopathy Screening

scholarly journals Safety and cost-effectiveness of individualised screening for diabetic retinopathy: the ISDR open-label, equivalence RCT

Diabetologia ◽  
2020 ◽  
Vol 64 (1) ◽  
pp. 56-69 ◽  
Author(s):  
Deborah M. Broadbent ◽  
◽  
Amu Wang ◽  
Christopher P. Cheyne ◽  
Marilyn James ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Cost Effectiveness ◽  
National Health Service ◽  
Time Horizon ◽  
Screening Programme ◽  
Variable Interval ◽  
Diabetic Retinopathy Screening ◽  
Screening Intervals ◽  
Retinopathy Screening

Abstract Aims/hypothesis Using variable diabetic retinopathy screening intervals, informed by personal risk levels, offers improved engagement of people with diabetes and reallocation of resources to high-risk groups, while addressing the increasing prevalence of diabetes. However, safety data on extending screening intervals are minimal. The aim of this study was to evaluate the safety and cost-effectiveness of individualised, variable-interval, risk-based population screening compared with usual care, with wide-ranging input from individuals with diabetes. Methods This was a two-arm, parallel-assignment, equivalence RCT (minimum 2 year follow-up) in individuals with diabetes aged 12 years or older registered with a single English screening programme. Participants were randomly allocated 1:1 at baseline to individualised screening at 6, 12 or 24 months for those at high, medium and low risk, respectively, as determined at each screening episode by a risk-calculation engine using local demographic, screening and clinical data, or to annual screening (control group). Screening staff and investigators were observer-masked to allocation and interval. Data were collected within the screening programme. The primary outcome was attendance (safety). A secondary safety outcome was the development of sight-threatening diabetic retinopathy. Cost-effectiveness was evaluated within a 2 year time horizon from National Health Service and societal perspectives. Results A total of 4534 participants were randomised. After withdrawals, there were 2097 participants in the individualised screening arm and 2224 in the control arm. Attendance rates at first follow-up were equivalent between the two arms (individualised screening 83.6%; control arm 84.7%; difference −1.0 [95% CI −3.2, 1.2]), while sight-threatening diabetic retinopathy detection rates were non-inferior in the individualised screening arm (individualised screening 1.4%, control arm 1.7%; difference −0.3 [95% CI −1.1, 0.5]). Sensitivity analyses confirmed these findings. No important adverse events were observed. Mean differences in complete case quality-adjusted life-years (EuroQol Five-Dimension Questionnaire, Health Utilities Index Mark 3) did not significantly differ from zero; multiple imputation supported the dominance of individualised screening. Incremental cost savings per person with individualised screening were £17.34 (95% CI 17.02, 17.67) from the National Health Service perspective and £23.11 (95% CI 22.73, 23.53) from the societal perspective, representing a 21% reduction in overall programme costs. Overall, 43.2% fewer screening appointments were required in the individualised arm. Conclusions/interpretation Stakeholders involved in diabetes care can be reassured by this study, which is the largest ophthalmic RCT in diabetic retinopathy screening to date, that extended and individualised, variable-interval, risk-based screening is feasible and can be safely and cost-effectively introduced in established systematic programmes. Because of the 2 year time horizon of the trial and the long time frame of the disease, robust monitoring of attendance and retinopathy rates should be included in any future implementation. Trial registration ISRCTN 87561257 Funding The study was funded by the UK National Institute for Health Research.

scholarly journals Irish National Diabetic RetinaScreen Programme: report on five rounds of retinopathy screening and screen-positive referrals. (INDEAR study report no. 1)

2020 ◽  
pp. bjophthalmol-2020-317508
Author(s):  
Rajiv Pandey ◽  
Margaret M Morgan ◽  
Colette Murphy ◽  
Helen Kavanagh ◽  
Robert Acheson ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Detection Rate ◽  
Screening Programme ◽  
Eye Disease ◽  
Community Based ◽  
Diabetic Retinopathy Screening ◽  
Significant Challenge ◽  
Diabetic Eye Disease ◽  
Screening Attendance ◽  
Retinopathy Screening

ObjectiveTo study the uptake of annual diabetic retinopathy screening and study the 5-year trends in the detection of screen-positive diabetic retinopathy and non-diabetes-related eye disease in a cohort of annually screened individuals.DesignRetrospective retinopathy screening attendance and retinopathy grading analysis.SettingCommunity-based retinopathy screening centres for the Diabetic RetinaScreen Programme.Participants171 557 were identified by the screening programme to be eligible for annual diabetic retinopathy screening. 120 048 individuals over the age of 12 consented to and attended at least one screening appointment between February 2013 to December 2018.Main Outcome MeasuresDetection rate per 100 000 of any retinopathy, screen-positive referrable retinopathy and nondiabetic eye disease.ResultsUptake of screening had reached 67.2% in the fifth round of screening. Detection rate of screen-positive retinopathy reduced from 13 229 to 4237 per 100 000 screened over five rounds. Detection of proliferative disease had reduced from 2898 to 713 per 100 000 screened. Non-diabetic eye disease detection and referral to treatment centres increased almost eightfold from 393 in round 1 to 3225 per 100 000 screened. The majority of individuals referred to treatment centres for ophthalmologist assessment are over the age of 50 years.ConclusionsScreening programme has seen a reduced detection rate both screen-positive retinopathy referral in Ireland over five rounds of screening. Management of nondiabetic eye diseases poses a significant challenge in improving visual outcomes of people living with diabetes in Ireland.

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.

Diabetic retinopathy screening: perspectives of people with diabetes, screening intervals and costs of attending screening

2012 ◽  
Vol 29 (7) ◽  
pp. 878-885 ◽  
Author(s):  
S. T. Yeo ◽  
R. T. Edwards ◽  
S. D. Luzio ◽  
J. M. Charles ◽  
R. L. Thomas ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Diabetes Screening ◽  
Diabetic Retinopathy Screening ◽  
Screening Intervals ◽  
Retinopathy Screening

scholarly journals Understanding the uptake of a national retinopathy screening programme: An audit of patients with diabetes in two large primary care centres

2019 ◽  
Vol 2 ◽  
pp. 17 ◽  
Author(s):  
Marsha Tracey ◽  
Emmy Racine ◽  
Fiona Riordan ◽  
Sheena M. McHugh ◽  
Patricia M. Kearney
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Primary Care Population ◽  
Diabetic Retinopathy Screening ◽  
A Priority ◽  
Rate Ratios ◽  
Measure Of Association ◽  
Retinopathy Screening

Background: Diabetic retinopathy (DR) affects 8.2% of the Irish population with type 2 diabetes over 50 years and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods:  In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of people eligible to participate in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake (consent and attendance) should be a priority.

scholarly journals Understanding the uptake of a national retinopathy screening programme: An audit of people with diabetes in two large primary care centres

2019 ◽  
Vol 2 ◽  
pp. 17 ◽  
Author(s):  
Marsha Tracey ◽  
Emmy Racine ◽  
Fiona Riordan ◽  
Sheena M. McHugh ◽  
Patricia M. Kearney
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Primary Care Population ◽  
Diabetic Retinopathy Screening ◽  
A Priority ◽  
Rate Ratios ◽  
Measure Of Association ◽  
Primary Care Practices ◽  
Retinopathy Screening

Background: Diabetic retinopathy (DR) is estimated to affect 25–26% of the Irish population with diabetes and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods: In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of eligible participants in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake, barriers to consent in particular, should be a priority.

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