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Ali S Hassan, Geeta Menon, Manju Chandran; UK Diabetic Screening Referrals Impact on Population and Clinical Correlations. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2905.
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© ARVO (1962-2015); The Authors (2016-present)
In the UK diabetic retinopathy screening programme an annual invitation is sent out and patients undergo fundal photography which is then observed by trained graders who refer patients to the hospital eye service. We reviewed referrals coming from the regional screening service to a busy tertiary hospital.
A retrospective review of referrals over a 4-month period from June 2016 to September 2016. We looked at patient age, reason for referral, time to appointment, retinopathy, other diagnoses, and outcome. Analysis of the correlation between screeners grading and clinicians grading was made.
A total of 161 referrals were made over the 4-month period averaging around 9 referrals per week. The mean age of patients was 66.43 (Range 21.68 - 93.95, SD 16.15), the mean time from referral being received to appointment was 20.27 days (Range 0 – 97, SD 19.85). The most common reasons cited for referrals were; un-assessable fundal image 33.64% [n=36], maculopathy 27.10% [n=29], retinopathy 10.28% [n=11] and proliferative disease 7.48 [n=8]. Of the patients referred with un-assessable fundal image cataract was found in 63.8% [n=23] – this was clinically significant and warranted operation in 15 patients, posterior capsule opacity in 5.5% [n=2], corneal scarring in 5.5% [n=2] and asteroid hyalosis in 2.7% [n=1]. In 25.0% [n=9] patients there was no identifiable cause for the un-assessable fundal image. In this group of patients the most common retinopathy grade was R0M0 (i.e. no retinopathy or maculopathy) in both eyes 72.2% [n=26]. Of the patients referred with worsening retinopathy (grade R2) 54.5% [n=6] correlated accurately with at least R2 retinopathy in at least one eye. Of the patients referred with maculopathy 68.9% [n=20] correlated accurately with maculopathy in at least one eye. Of the patients referred with proliferative retinopathy 50% [n=4] correlated accurately with active proliferative disease in at least one eye.
The largest impact of the diabetic screening service would appear to have been in identify and refer patients with cataract, the vast majority of whom have no retinopathy. The screeners were most accurate with detecting maculopathy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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