10 year observational study of patient related outcomes during expansion to full population coverage of a systematic diabetes eye care programme – the Liverpool Diabetic Eye Study

Abstract

Purpose : To report long term changes over time of patient related outcomes of sight threatening retinopathy and treatment rates in a systematic diabetic retinopathy detection and management programme.

Methods : Data from established digital photographic screening and primary and secondary care systems were combined in a purpose built observational cohort repository and investigated in the context of a population based epidemiological study. Individuals were identified in a whole population disease register maintained as part of routine care. The local ethics committee approved an opt-out approach to consent. Effects of increasing population size and changing clinical practice were examined.

Results : The screening programme size increased as follows: 2006 - 10,322, 2012 – 15,789, 2014 – 16,585. Annual incidence of STDR remained stable over the 9 years: mean 2.28% (range 1.87-2.59). The cohort dataset contained follow-up data on treatment for 19,070 people with diabetes (100,070 person years) between 2007 and 2015. Annual proportions of people undergoing laser remained stable at 2.15% (range 1.46-2.46). Numbers of laser procedures rose from under 2 per person prior to 2012 to around 3 from 2012. Numbers of intravitreal injections increased rapidly in later years to an estimated 840 procedures in 2015. Numbers of vitrectomies stayed low at below 1%.

Conclusions : Over a 10 year period coinciding with an expansion of screening, annual incidence of STDR remained consistent. Intravitreal injection rates increased substantially in line with introduction of antiVEGF therapy into clinical practice but there was also a moderate increase in numbers of laser procedures. Vitrectomy rates stayed low. These data give important information on rates of STDR and treatments in population based management.

This abstract presents independent research funded by the National Institute for Health Research (RP-PG-1210-12016). The views expressed are those of the authors, not those of the NHS, NIHR or Department of Health.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.