Information Technology to Control Screening for Diabetic Retinopathy

Abstract

Purpose: : We use information technology and individualized risk assessment to determine screening intervals for diabetic eye disease. The purpose is to standardize risk and economize screening programs.

Methods: : Diabetic eye screening programs in Reykjavik, Iceland and Århus, Denmark have accumulated data on diabetic eye disease for up to 30 years. These databases were used to test and refine risk assessment algorithms for diabetic retinopathy, which were based on published epidemiological studies.

Results: : When tested against the diabetes data base in Århus, Denmark (5210 patients) the algorithm suggested an average screening interval of 27 months at risk margin 4% and 95 patients progressed to sight threatening retinopathy within the recommended screening interval. At risk margin 2% the respective numbers are 17 months and 32 patients. Using the standard screening program (yearly screening exams) 149 patients progressed to sight threatening retinopathy within the recommended screening interval. Hence the algorithm, at risk margin 4%, increases safety by 36% while reducing cost of diabetic screening programs by 55% as compared to yearly screening exams. The respective numbers at the 2% risk margin are increased safety by 79% and cost reduction of 30%.

Conclusions: : The use of information technology based on available epidemiological studies allows standardization of risk and a practical determination of screening intervals for diabetic eye disease. The reduction in screening visits may decrease cost of diabetic screening programs compared to programs with yearly screening exams. The screening program can be adjusted and implemented in accordance with safety and cost-reduction results based on desired results from any given health care system. The information technology system will be further developed and refined. The algorithm is available on www.risk.is.

Keywords: diabetic retinopathy • diabetes • retina