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G. C. Vafidis, M. Moosajee, J. C. Bladen; Challenging the Burden of Diabetic Retinopathy Through Screening and Arbitration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2145.
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Diabetes Mellitus (UK prevalence 2-4%, worldwide prevalence 180 million) is a leading cause of blindness in the developed world. The Greater London Borough of Brent houses the most ethnically diverse population in the UK, with a 121 different languages spoken, the most common being Gujarati, Urdu, Somali and Arabic. The local population have a higher than national prevalence of diabetes, reaching 5.7%. In 2006, a national diabetic screening programme was introduced to reduce new blindness from diabetic retinopathy. This study evaluates the community-based screening programme with appraisal of recruitment and arbitration.
Diabetic population of Brent is 16,163; screening invitations to community-based clinics for 2 digital retinal images per eye, were counted over a one year period. The Topcon TRC NW6S and Nikon D70 camera with OptoMize® iP® capture and management software from Digital Healthcare was used for imaging and analysis. For attenders, the diabetic retinopathy grading system followed national screening committee guidelines. Outcomes, referral to hospital eye service (HES) or return to annual screening, and arbitration was measured.
Only 77% (12,454) of the diabetic population were invited for screening, with 47% (7,613) of patients being screened. Just 9% (720) of screenees were referred to the HES, the remainder returned to annual screening. Arbitration grading occurred in 11% (895) of screened patients. In 83% (593) of these arbitrated diabetics, where grading differed but an outcome of annual screening was reached, arbitration altered 1 outcome to HES.
The diabetic screening programme is an important tool in combating new blindness. Screening of just under half of all diabetics residing in Brent has highlighted a poor uptake of patients into the programme. Recruitment must be increased by improving communication and education within the community, using GPs and public awareness campaigns. Arbitration rates were found to be unnecessarily high. We propose this can be reduced to 10% of cases where there is an outcome of return to annual screening by the graders. To conclude, this study shows the national diabetic screening programme is not as effective in London suburbs with a diverse ethnic population. A recruitment drive is necessary to reach all diabetics, and arbitration can be safely reduced leading to cost effectiveness within this healthcare system.
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