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Ecosse Luc Lamoureux, Melanie Larizza, Eva K Fenwick, Ryan EK Man, Charumathi Sabanayagam, Marian Saeed, Gwyn Rees, Lauren Hodgson, Tien Yin Wong; A novel program to improve adherence to diabetic retinopathy screening with fundus photography at pathology centers: the Ret-Path study. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
A third of Australians with diabetes is estimated to be non-adherent with the recommended biennial eye screening guidelines. As 90% of people with diabetes visit a pathology centre yearly, we investigated the effectiveness of an opportunistic diabetic retinopathy (DR) screening modality (Ret-Path) to assess feasibility and effectiveness of this novel screening model.
In this prospective and multi-sited study, individuals with diabetes (≥12 years), visited 10 participating urban and rural pathology centers between 2011 and 2015 in Victoria, Australia. Those with no eye examination in the last 2 years (self-reported) were classified as “non-adherent” and invited to participate. Two-field fundus images were taken using a non-mydriatic retinal camera by trained pathology center staff. Images were transferred electronically and graded for DR and other pathology by experienced graders. We assessed the rate of non-adherence; acceptance rate of Ret-Path; referral rate and reasons for referral; ability of Ret-Path to screen for other ocular pathologies; testing time; proportion of gradable images; and patient satisfaction.
In total, 62,776 people were screened, of which 5508 had diabetes. Of these, 649 (11.8%) were non-adherent to eye screening; and of these, 349 (53.8%) agreed to undergo Ret-Path (mean age±SD 62.6±13.9, 57.3% male). Reasons for decline (n=300, 46.2%) included: ‘interested, but unable at present’ (24.3%), ‘too busy’ (17.3%), ‘prefer own eye doctor’ (17.3%), and ‘not interested’ (12.0%). Of those who had retinal photography (n=346), 67 (19.4%) were found to have DR, of which 91% (n=61) were unaware of the condition. 228 participants (65.3%) required referral for DR and/or other significant ocular pathology. Fundus photography took on average 14±8 mins, and 25.6% of images were ungradable requiring automatic referral. 95% of participants were satisfied with the photographic procedure and would likely use the service again.
Overall, Ret-Path is a viable, effective, and acceptable real-world modality to address the issue of non-adherence with DR screening. Several of the reasons offered for the modest uptake of Ret-Path are amenable to interventions. Additional training for pathology center staff would reduce the rate of ungradable images needing automatic referrals.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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