Andalusian program for early detection of diabetic retinopathy: implementation and 15-year follow-up of a population-based screening program in Andalusia, Southern Spain

IntroductionDiabetic retinopathy (DR) is a preventable cause of vision loss and blindness worldwide. We aim at analyzing the impact of a population-based screening program of DR using retinal photography with remote reading in terms of population coverage, diagnosis of asymptomatic DR and impact on visual disability, in the region of Andalusia, Spain, in the period 2005–2019.Research design and methodsDescriptive study. Sociodemographic and clinical features included in the Andalusian program for early detection of diabetic retinopathy (APDR) were analyzed. Population coverage, annual incidence of DR, and DR severity gradation were analyzed. Estimated data on prevalence and incidence of legal blindness due to DR were included.Results407 762 patients with at least one successful DR examination during the study period were included. Most of the performed retinographies (784 584, 84.3%) were ‘non-pathological.’ Asymptomatic DR was detected in 52 748 (5.9%) retinographies, most of them (94.2%) being classified as ‘mild to moderate non-proliferative DR.’ DR was detected in 44 815 patients, while sight-threatening DR (STDR) in 6256 patients; cumulative incidence of DR was 11.0% and STDR was 1.5%, as DR and STDR was detected in 44 815 and 6256 patients, respectively. Annual incidence risk per patient recruitment year progressively decreased from 22.0% by January 2005 to 3.2% by June 2019.ConclusionsImplementation of a long-term population-based screening program for early detection of DR is technically feasible and clinically viable. Thus, after 15 years of existence, the program has enabled the screening of the vast majority of the target population allowing the optimization of healthcare resources and the identification of asymptomatic DR.

Download Full-text

Mo1702 The Effect of Population-Based Colorectal Cancer Screening Program in the Czech Republic on Target Population Coverage

Gastroenterology ◽

10.1016/s0016-5085(16)32567-7 ◽

2016 ◽

Vol 150 (4) ◽

pp. S756-S757

Author(s):

Stepan Suchanek ◽

Ondrej Majek ◽

Ondrej Ngo ◽

Tomas Grega ◽

Bohumil Seifert ◽

...

Keyword(s):

Colorectal Cancer ◽

Czech Republic ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Target Population ◽

Population Based ◽

Population Coverage ◽

The Czech Republic ◽

Cancer Screening Program

Download Full-text

Beyond vision loss: the independent impact of diabetic retinopathy on vision-related quality of life in a Chinese Singaporean population

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313082 ◽

2018 ◽

Vol 103 (9) ◽

pp. 1314-1319 ◽

Cited By ~ 1

Author(s):

Eva K Fenwick ◽

Ryan E K Man ◽

Alfred Tau Liang Gan ◽

Neelam Kumari ◽

Charlene Wong ◽

...

Keyword(s):

Quality Of Life ◽

Diabetic Retinopathy ◽

Vision Loss ◽

Well Being ◽

Linear Regression Models ◽

Cross Sectional ◽

Significant Difference ◽

Related Quality ◽

The Impact

Background/aimsTo assess the independent impact of diabetic retinopathy (DR) on three domains of vision-related quality of life (VRQoL) in a Chinese Singapore population.MethodsThe Singapore Chinese Eye Study (n=3353; 2009–2011) was a population-based, prospective, cross-sectional study conducted at the Singapore Eye Research Institute. The study population included 292 adults with diabetes, with and without DR. DR (better eye) was categorised as presence and absence of any DR; severity of DR (no vision-threatening DR (VTDR); severe non-proliferative DR (NPDR); PDR and/or clinically significant macular oedema and VTDR). Our main outcome was VRQoL which was measured using Rasch-calibrated scores from the ‘Reading’, ‘Mobility’ and ‘Emotional’ domains of the Impact of Vision Impairment questionnaire. The relationship between DR and VRQoL was assessed using multiple linear regression models.ResultsOf the 292 individuals (mean age 61.35 ± 9.66 years; 55.8% male), 201 (68.8%), 49 (16.8%), 20 (6.8%), 22 (7.5%) and 27 (9.2%) had no DR, minimal-mild NPDR, moderate-severe NPDR, PDR and VTDR, respectively. Any DR and VTDR were independently associated with 6% and 12% worse Reading scores and 7% and 18% poorer Emotional well-being, respectively, compared with those without DR. These associations persisted after separate adjustment for visual impairment and presenting visual acuity. No significant difference was found in the Mobility domain between persons with and without DR.ConclusionsWe documented that DR, particularly VTDR, was independently associated with restrictions in Reading and Emotional well-being. Understanding factors underlying the detrimental DR-VRQoL relationship may optimise rehabilitation outcomes for individuals with DR.

Download Full-text

A population-based screening program for early detection of common cancers among women in India – methodology and interim results

Indian Journal of Cancer ◽

10.4103/0019-509x.175581 ◽

2015 ◽

Vol 52 (1) ◽

pp. 139 ◽

Cited By ~ 4

Author(s):

GA Mishra ◽

HD Dhivar ◽

SD Gupta ◽

SV Kulkarni ◽

SS Shastri

Keyword(s):

Early Detection ◽

Screening Program ◽

Population Based ◽

Women In India

Download Full-text

Poor person and areal socioeconomic status is associated with increased diabetic retinopathy and visual impairment incidence and progression

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316430 ◽

2020 ◽

pp. bjophthalmol-2020-316430

Author(s):

Jin Rong Low ◽

Alfred Tau Liang Gan ◽

Eva K Fenwick ◽

Preeti Gupta ◽

Tien Y Wong ◽

...

Keyword(s):

Socioeconomic Status ◽

Diabetic Retinopathy ◽

Visual Impairment ◽

Low Socioeconomic Status ◽

Low Income ◽

Vision Loss ◽

Population Based ◽

Housing Type ◽

Incidence Risk

BackgroundTo investigate the longitudinal associations between person-level and area-level socioeconomic status (PLSES and ALSES, respectively) with diabetic retinopathy (DR) and visual impairment (VI) in Asians with diabetes mellitus (DM).MethodsIn this population-based cohort study, we included 468 (39.4%) Malays and 721 (60.6%) Indians with DM, with a mean age (SD) of 58.9 (9.1) years; 50.6% were female and the mean follow-up duration was 6.2 (0.9) years. Individual PLSES parameters (education, monthly income and housing type) were quantified using questionnaires. ALSES was assessed using the Socioeconomic Disadvantage Index derived from Singapore’s 2010 areal census (higher scores indicate greater disadvantage). Incident DR and VI were defined as absent at baseline but present at follow-up, while DR and VI progression were defined as a ≥1 step increase in severity category at follow-up. Modified Poisson regression analysis was used to determine the associations of PLSES and ALSES with incidence and progression of DR and VI, adjusting for relevant confounders.ResultsIn multivariable models, per SD increase in ALSES score was associated with greater DR incidence (risk ratio (95% CI) 1.27 (1.13 to 1.44)), DR progression (1.10 (1.00 to 1.20)) and VI incidence (1.10 (1.04 to 1.16)), while lower PLSES variables were associated with increased DR (low income: 1.68 (1.21 to 2.34)) and VI (low income: 1.44 (1.13 to 1.83); ≤4 room housing: 2.00 (1.57 to 2.54)) incidence.ConclusionsWe found that both PLSES and ALSES variables were independently associated with DR incidence, progression and associated vision loss in Asians. Novel intervention strategies targeted at low socioeconomic status communities to decrease rates of DR and VI are warranted.

Download Full-text

Poorer Quality of Life and Treatment Satisfaction is Associated with Diabetic Retinopathy in Patients with Type 1 Diabetes without Other Advanced Late Complications

Journal of Clinical Medicine ◽

10.3390/jcm8030377 ◽

2019 ◽

Vol 8 (3) ◽

pp. 377 ◽

Cited By ~ 3

Author(s):

Minerva Granado-Casas ◽

Esmeralda Castelblanco ◽

Anna Ramírez-Morros ◽

Mariona Martín ◽

Nuria Alcubierre ◽

...

Keyword(s):

Quality Of Life ◽

Type 1 Diabetes ◽

Diabetic Retinopathy ◽

Treatment Satisfaction ◽

Vision Loss ◽

Multivariable Analysis ◽

Work Life ◽

The Impact

Diabetic retinopathy (DR) may potentially cause vision loss and affect the patient’s quality of life (QoL) and treatment satisfaction (TS). Using specific tools, we aimed to assess the impact of DR and clinical factors on the QoL and TS in patients with type 1 diabetes. This was a cross-sectional, two-centre study. A sample of 102 patients with DR and 140 non-DR patients were compared. The Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) and Diabetes Treatment Satisfaction Questionnaire (DTSQ-s) were administered. Data analysis included bivariate and multivariable analysis. Patients with DR showed a poorer perception of present QoL (p = 0.039), work life (p = 0.037), dependence (p = 0.010), and had a lower average weighted impact (AWI) score (p = 0.045). The multivariable analysis showed that DR was associated with a lower present QoL (p = 0.040), work life (p = 0.036) and dependence (p = 0.016). With regards to TS, DR was associated with a higher perceived frequency of hypoglycaemia (p = 0.019). In patients with type 1 diabetes, the presence of DR is associated with a poorer perception of their QoL. With regard to TS, these subjects also show a higher perceived frequency of hypoglycaemia.

Download Full-text

Early Detection of Diabetic Retinopathy Using PCA-Firefly Based Deep Learning Model

Electronics ◽

10.3390/electronics9020274 ◽

2020 ◽

Vol 9 (2) ◽

pp. 274 ◽

Cited By ~ 30

Author(s):

Thippa Reddy Gadekallu ◽

Neelu Khare ◽

Sweta Bhattacharya ◽

Saurabh Singh ◽

Praveen Kumar Reddy Maddikunta ◽

...

Keyword(s):

Machine Learning ◽

Diabetic Retinopathy ◽

Deep Learning ◽

Early Detection ◽

Dimensionality Reduction ◽

Vision Loss ◽

Principal Component ◽

Screening Methods ◽

Learning Approaches ◽

Time Period

Diabetic Retinopathy is a major cause of vision loss and blindness affecting millions of people across the globe. Although there are established screening methods - fluorescein angiography and optical coherence tomography for detection of the disease but in majority of the cases, the patients remain ignorant and fail to undertake such tests at an appropriate time. The early detection of the disease plays an extremely important role in preventing vision loss which is the consequence of diabetes mellitus remaining untreated among patients for a prolonged time period. Various machine learning and deep learning approaches have been implemented on diabetic retinopathy dataset for classification and prediction of the disease but majority of them have neglected the aspect of data pre-processing and dimensionality reduction, leading to biased results. The dataset used in the present study is a diabetes retinopathy dataset collected from the UCI machine learning repository. At its inceptions, the raw dataset is normalized using the Standardscalar technique and then Principal Component Analysis (PCA) is used to extract the most significant features in the dataset. Further, Firefly algorithm is implemented for dimensionality reduction. This reduced dataset is fed into a Deep Neural Network Model for classification. The results generated from the model is evaluated against the prevalent machine learning models and the results justify the superiority of the proposed model in terms of Accuracy, Precision, Recall, Sensitivity and Specificity.

Download Full-text

The effect of deprivation on uptake and outcomes in a population-based FOBt colorectal cancer screening program.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3599 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3599-3599

Author(s):

David Mansouri ◽

Donald C. Mcmillan ◽

Emilia M Crighton ◽

Paul G Horgan

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Program ◽

Geographical Area ◽

Population Based ◽

Socioeconomic Deprivation ◽

Screening Process ◽

Background Population ◽

The Impact

3599 Background: Population-based FOBt colorectal cancer screening has been shown to reduce cancer specific mortality and is used across the UK. Despite evidence that socioeconomic deprivation is associated with increased incidence of colorectal cancer, uptake of screening may be lower in those who are more deprived. The aim of this study was to assess the impact of deprivation on the screening process. Methods: A prospectively maintained database, encompassing the first screening round in a single geographical area, was analysed with deprivation categories calculated from the Scottish Index of Multiple Deprivation 2009. Results: Overall, 395,698 individuals were invited to screening, 204,812(52%) participated and 6,094(3%) tested positive. 32% of screened individuals were in the most deprived quintile. Of the positive tests, 5,457(95%) agreed to be pre-assessed for colonoscopy. 839(16%) did not proceed to colonoscopy following pre-assessment. Of the 4,618 that attended for colonoscopy, cancer was detected in 7%. Colonoscopy results were not recorded in 1,035(22%) cases. Lower uptake of screening was seen in males, those that were younger and those who were more deprived (p<0.001). Higher levels of deprivation were also associated with not proceeding to colonoscopy following pre-assessment (p<0.001). Higher positivity rates were seen in males, those that were older and more deprived (p<0.001). Despite higher positivity rates in the more deprived individuals (4% most deprived vs 2% least deprived, p<0.001), the positive predictive value of detecting cancer in those attending for colonoscopy was lower in those who were more deprived (6% most deprived vs 8% least deprived, p=0.040). Conclusions: Socioeconomic deprivation has a significant effect throughout the FOBt screening process. Individuals who are more deprived are less likely to participate in screening, less likely to complete the screening process and less likely to have cancer identified as a result of a positive test. This study adds further weight to existing evidence that individuals who are more deprived are less likely to engage in population-based FOBt colorectal cancer screening. Novel strategies to improve this are required.

Download Full-text

Screening for colorectal cancer in France: Third edition of the EDIFICE survey.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.411 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 411-411

Author(s):

Jérôme Viguier ◽

Jean F. Morere ◽

Xavier B. Pivot ◽

Yvan Coscas ◽

Jean-Yves Blay ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Test ◽

Screening Program ◽

Age Groups ◽

Target Population ◽

Population Based ◽

Screening Process ◽

Nationwide Observational Study

411 Background: In France, after a pilot population-based screening program (2002-2003), a national organized program targeting 17 million persons was progressively implemented starting in 2005 and generalized after 2009. The EDIFICE 3 survey was conducted in 2011, after EDIFICE 1 (2005) and EDIFICE 2 (2008), to provide a better understanding of the participation of the French population in the colorectal cancer screening program and to assess the evolution between the three periods. Methods: This third nationwide observational study, EDIFICE 3, was conducted through phone interviews among a representative sample of 1603 subjects aged between 40 and 75years, using the quota method. This analysis focused on the target population of the national screening program (50-74 years old). Results: In 2011, 59% of subjects between 50 and 74 years (N=946) declared having performed a screening test for colorectal cancer (including fecal test or colonoscopy) versus 38% in 2008 (p<0.05) and 25% in 2005 (p<0.05). Colorectal cancer screening increased significantly in all age groups, especially between 65 and 69 years, and for both sexes. Among the screened population, the recommended interval between two tests was respected in 51% of cases in EDIFICE 3. 62% of unscreened individuals plan to undergo a screening test in the near future. The main factors increasing the probability of screening were: being encouraged by one’s family, the existence of a case colorectal cancer in the family circle, higher frequency of medical consultation, better knowledge of the screening process and being reassured by the screening. The main reasons for not undergoing the screening were: not feeling concerned, fear of exams or results, no recommendation by the GP and carelessness. Conclusions: The European guideline objective rate of participation for colorectal cancer screening (65%) is not yet reached. This goal could be achieved by motivating the unscreened population already planning to perform a test. The trend for increasing testing will probably be confirmed in the future if the reasons for non-attendance in an organized program are addressed.

Download Full-text