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Melanie F. Larizza, Eva K. Fenwick, Lauren A. Hodgson, Jie J. Wang, Tien Y. Wong, Ecosse L. Lamoureux; The Evaluation of a Novel Diabetic Retinopathy Screening Model in Individuals with Diabetes Mellitus in Urban Victoria (Australia): Pilot Phase. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1404. doi: https://doi.org/.
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To evaluate the effectiveness, acceptability and testing protocol of a novel diabetic retinopathy (DR) screening model using pathology centres as screening sites. This is an opportunistic screening model based on the premise that over 85% of Australians with diabetes mellitus (DM) visit a pathology centre annually for a DM-related test.
Over 6 months, pilot testing occurred in one urban pathology centre (Victoria, Australia). Participants were 1) English speaking, 2) had type I or II DM, 3) aged 12 years or older and 4) had not undertaken the recommended eye examination over the previous two years. Prior to data collection, two pathology personnel were trained onsite in interviewing techniques, non-mydriatic fundus photography and distance LogMAR visual acuity (VA) testing. Participants received non-stereoscopic, colour fundus photography (2-fields, centered on the ; optic disc and macula centred) and underwent a distance VA assessment. Socio-demographic data including age, gender, self-reported diabetes (i.e., type, duration and treatment), ocular history and general health were collected as well as feedback on the DR screening model. DR was graded from fundus photographs using the modified Airlie House Classification (Wisconsin system).
Two pathology personnel successfully completed our onsite training course and were certified to perform fundus photography. Gradable fundus photographs of both eyes were obtained in 94.5% of our participants and for almost half (n=45 participants), fundus photography took 5 minutes or less. Over 6 months, 289 English speaking patients with DM were screened, with 99 (34.3%) admitting non-compliance with DR screening guidelines. Of these, 93 (92.1%) accepted our screening service. Sixteen (17.2%) cases of DR were found, comprising 6, 8 and 2 cases of moderate NPDR, mild NPDR and minimal NPDR in the worst eye, respectively. Participants and staff positively evaluated our DR screening model; 98.9% of participants would recommend this service.
One in 3 people with DM remains non-compliant with the Australian guidelines for regular DR screening. Screening for DR in pathology centres using non-mydriatic fundus photography is a well-accepted and effective approach for increasing screening coverage and has the potential to play an important public health role in preventing vision impairment in people with diabetes.
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