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T. Peto, C. Schmermer, I. Leung, N. Harris; Results of a Diabetic Retinopathy Screening Programme in East–London . Invest. Ophthalmol. Vis. Sci. 2006;47(13):337.
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Diabetic retinopathy (DR) is the leading cause of blindness in the working age–group in the United Kingdom. A UK government–led initiative, the National Service Framework (NSF), provides guidance for DR screening and audit. The Reading Centre (RC) at Moorfields Eye Hospital (MEH) plays an important role in training personnel, conducting screening and carrying out quality control for the East London DR Screening Program. This audit analyzed the outcomes from the first 2.5 years' of DR screening.
Yearly audits have been completed by comparing the program's achievement to the national guidelines (www.nscretinopathy.org.uk). The original 15 guidelines concentrated on administrative tasks, grading of screening photographs and its quality control and finally, clinical treatment requirements and the ways these were delivered to the population screened. All screeners have successfully completed the NSF–based training program at the RC which was a pre–requisite to participate in the program.
A total of 6184 (68.7% of known patients with diabetes in the area) patients were screened between October 2002 and April 2005. Of these, 338 (5.5%) were referred for ophthalmic review (33 cataracts, 20 proliferative DR, 15 maculopathy, 99 referable retinopathy and maculopathy, 27 other retinal pathologies). Intra– and inter–grader agreement for quality control grading was over 95% for entering the patient into the appropriate clinical pathway. The screening–clinical interface was the most problematic; in the first year 46%, in the second 22%, and in the last half a year, after employing a dedicated person to deal with screening referrals, only 19% of referrals were outside of government guidelines. The NSF treatment guidelines have been adhered to by MEH.
The DR screening service provides a valuable service by promptly and efficiently dealing with 94.5% of the patients at the level of first contact. These patients with diabetes required no ophthalmic review. Thus patients needing ophthalmic treatment could be dealt with promptly and efficiently.
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