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S. J. Maling, V. Vora, K. Scanlon, G. Vafidis; Effect of Vision Test Retraining on National Screening Programme Referrals for Diabetic Maculopathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4691.
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In the English National Screening Programme for Diabetic Retinopathy (ENSPDR) criteria for referable maculopathy (M1) comprise both exudate and any retinopathy found on digital non-stereoscopic 450 images when combined with visual acuity (VA) below 0.28 LogMAR. This study aimed to quantify disagreements between ENSPDR and clinic maculopathy grades before and after all VA test staff were retrained.
ENSPDR and clinic (standard photographs and slit lamp biomicroscopy) DR grades were collected from consecutive new patients referred from one screening programme since April 2008. Data were subsequently analysed pre and post VA test retraining.
Of 663 patients, 617 (93%) were referred with M1 grade in one or both eyes. 194 M1 patients were referred pre vision retraining and 434 post. Taking right eyes, pre-retraining grade disagreements occurred in 35% (38/108) eyes, 61% because of above threshold VA in clinic. Post-retraining M1 grade disagreements reduced to 19% (42/223), 28% due to above threshold clinic VA. Left eyes had similar findings: pre-retraining disagreements 32% (32/100) 63% due to clinic VA, post-retraining 17% (41/240), with 39% (16/41) due to clinic VA. Overall, before vision retraining 37.6% right eye (33.3% left) referrals were for exudate and 18% (18.8%) for below threshold VA, after training 51.4% (55.6% left) were exudate and only 6.68% right (6.48%) for below threshold VA .
Our study found a three fold decrease in proportion of M1 referrals due to below threshold VA following retraining. This was associated with fewer disagreements between ENSPDR and clinic VA tests. There was also improvement in exudate agreement in referrals which may represent improved interpretation of macular white dots. Referrals for maculopathy make up the majority of ENSPDR new patients and we found that this small intervention had the effect of improving grade agreement with clinic findings and preventing unnecessary hospital appointments
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