American Diabetes Association Issues Diabetic Retinopathy Position Statement
American Diabetes Association Issues Diabetic Retinopathy Position Statement Updated recommendations include new diagnostic technology and treatment guidelines Diabetes affects the entire body and can result in long-term complications, including damage to the small blood vessels. Such damage can lead to problems in the retina of the eye, a condition known as diabetic retinopathy. The American Diabetes Association (Association) has issued updated guidelines on prevention, assessment and treatment of diabetic retinopathy for providers and for people with diabetes. The detailed recommendations are featured in the article, "Diabetic Retinopathy: A Position Statement by the American Diabetes Association," to be published in the March 2017 issue of Diabetes Care , and online on February 21, 2017. The position statement includes information on advancements in diabetic retinopathy assessment and treatment methods, as well as improvements in managing diabetes that have developed since its prior diabetic retinopathy position statement in 2002. New diagnostic developments include the widespread adoption of optical coherence tomography, as well as intraretinal pathology and wide-eld fundus photography. Newer treatment modalities, including intravitreous injection of antivascular endothelial growth factor agents, are also outlined in the statement. "Diabetic retinopathy is actually the most common cause of new cases of blindness in adults who live in developed countries and are between the ages of 20 and 74," said Thomas W. Gardner, MD, MS, corresponding author of the article and professor of ophthalmology and visual sciences at the Kellogg Eye Center at the University of Michigan."Over the past decade, new research and significant improvements in technology have aided our ability Continue reading >>
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Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study In Hungary
Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study in Hungary 1Department of Public Health, University of Szeged, Szeged, Hungary 2Department of Ophthalmology, Albert Szent-Gyrgyi Clinical Center, University of Szeged, Szeged, Hungary 3Health Intelligence, Clinical Development, Chesire, UK 4Centre of Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway 5Health Services Research Centre, Akershus University Hospital, Lrenskog, Norway 6Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway Received 9 September 2016; Revised 27 October 2016; Accepted 3 November 2016 Copyright 2016 Dra J. Eszes et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Diabetic retinopathy (DR) is a sight-threatening complication of diabetes. Telemedicine tools can prevent blindness. We aimed to investigate the patients satisfaction when using such tools (fundus camera examination) and the effect of demographic and socioeconomic factors on participation in screening. Methods. Pilot study involving fundus camera screening and self-administered questionnaire on participants experience during fundus examination (comfort, reliability, and future interest in participation), as well as demographic and socioeconomic factors was performed on 89 patients with known diabetes in Csongrd County, a southeastern region of Hungary. Results. Thirty percent of the patients had never participated in any ophthalmological screening, while 25.7% had DR of some grade based upon a standard fundus camera examination and UK-based DR grading protocol (S Continue reading >>
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The English National Screening Programme For Diabetic Retinopathy 2003-2016.
The English National Screening Programme for diabetic retinopathy 2003-2016. The English NHS Diabetic Eye Screening Programme, Gloucestershire Diabetic Retinopathy Research Group, Office above Oakley Ward, Cheltenham General Hospital, Sandford Road, Cheltenham, GL53 7AN, UK. [email protected] Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK. [email protected] Acta Diabetol. 2017 Jun;54(6):515-525. doi: 10.1007/s00592-017-0974-1. Epub 2017 Feb 22. The aim of the English NHS Diabetic Eye Screening Programme is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process. In order to achieve the delivery of evidence-based, population-based screening programmes, it was recognised that certain key components were required. It is necessary to identify the eligible population in order to deliver the programme to the maximum number of people with diabetes. The programme is delivered and supported by suitably trained, competent, and qualified, clinical and non-clinical staff who participate in recognised ongoing Continuous Professional Development and Quality Assurance schemes. There is an appropriate referral route for those with screen-positive disease for ophthalmology treatment and for assessment of the retinal status in those with poor-quality images. Appropriate assessment of control of their diabetes is also important in those who are screen positive. Audit and internal and external quality assurance schemes are embedded in the service. In England, two-field mydriatic digital photographic screening is offered annually to all people with diabetes aged 12years and over. The programm Continue reading >>
Diabetic Eye Screening Annual Data 1 April 2015 To 31 March 2016
Diabetic eye screening annual data 1 April 2015 to 31 March 2016 Today, we are delighted to publish annual diabetic eye screening data by local provider in England for the period 1 April 2015 to 31 March 2016 . This is the first time PHE Screening has been able to publish such data. Many thanks to our local providers for all their help. Diabetic eye screening reduces the risk of sight loss among people with diabetes through the early identification of sight-threatening diabetic retinopathy, appropriate follow-up and treatment. Since November 2013, local providers in England have been moving to software that is compliant with the common pathway for diabetic eye screening. This means every provider now uses a common dataset and common way of reporting. As a result, we now have comparable data that we can report nationally to help drive up quality and consistency. We have been working with providers and software suppliers to ensure the data reporting is accurate. 1 April 2015 to 31 March 2016 is the first screening year that most local providers (68 out of 70) have been able to report full common pathway compliant data. It is also the first year that weve asked for data reported by responsible clinical commissioning group (CCG). The responsible CCG is the CCG that includes the GP practices that refer into a particular service. The CCG level data is not as complete as the provider level data due to changes in service provider and boundaries but this should improve in the future. More than 2 million eligible people with diabetes were screened between 1 April 2015 and 31 March 2016.This equates to an uptake of routine digital eye screening of 82.5%. Uptake ranged from 70.0% to 91.9%. All providers met the acceptable threshold of 70.0%. Regional uptake of diabetic eye screeni Continue reading >>
Diabetic Eye Screening: 2015 To 2016 Data
Diabetic eye screening: 2015 to 2016 data These tables set out the 2015 to 2016 data for the local diabetic eye screening services inEngland. This file may not be suitable for users of assistive technology. Request an accessible format. If you use assistive technology (such as a screen reader) and need aversion of this document in a more accessible format, please email [email protected] .Please tell us what format you need. It will help us if you say what assistive technology you use. This file may not be suitable for users of assistive technology. Request an accessible format. If you use assistive technology (such as a screen reader) and need aversion of this document in a more accessible format, please email [email protected] .Please tell us what format you need. It will help us if you say what assistive technology you use. The data tables in this document include: uptake of routine digital screening by local screening programme uptake of routine digital screening by clinical commissioning group percentage of new additions to the service register who are offered an appointment within 3 months of notification to the service rate of ungradable images and diabetic retinopathy referrals per 100,000 screens rate of ungradable images and referable diabetic retinopathy grades per 100,000 screens timeliness of routine digital screening results letters to patients and GPs referral to and attendance for consultation at hospital eye services (HES) Continue reading >>
Screening For Diabetic Retinopathy Using Computer Based Image Analysis And Statistical Classification
Volume 62, Issue 3 , July 2000, Pages 165-175 Screening for diabetic retinopathy using computer based image analysis and statistical classification Author links open overlay panel Bernhard M.Egea Get rights and content Diabetic retinopathy is one of the most common causes of blindness in Europe. However, efficient therapies do exist. An accurate and early diagnosis and correct application of treatment can prevent blindness in more than 50% of all cases. Digital imaging is becoming available as a means of screening for diabetic retinopathy. As well as providing a high quality permanent record of the retinal appearance, which can be used for monitoring of progression or response to treatment, and which can be reviewed by an ophthalmologist, digital images have the potential to be processed by automatic analysis systems. We have described the preliminary development of a tool to provide automatic analysis of digital images taken as part of routine monitoring of diabetic retinopathy in our clinic. Various statistical classifiers, a Bayesian, a Mahalanobis, and a KNN classifier were tested. The system was tested on 134 retinal images. The Mahalanobis classifier had the best results: microaneurysms, haemorrhages, exudates, and cotton wool spots were detected with a sensitivity of 69, 83, 99, and 80%, respectively. Continue reading >>
Diabetic Retinopathy
Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes and is a leading cause of blindness.[1] It affects up to 80 percent of people who have had diabetes for 20 years or more.[2] At least 90% of new cases could be reduced if there were proper treatment and monitoring of the eyes.[3] The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy.[4] Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness for people aged 20 to 64 years.[5] Signs and symptoms[edit] Normal vision The same view with diabetic retinopathy. Emptied retinal venules due to arterial branch occlusion in diabetic retinopathy (fluorescein angiography) Diabetic retinopathy often has no early warning signs. Even macular edema, which can cause rapid vision loss, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day. In the first stage which is called non-proliferative diabetic retinopathy (NPDR) there are no symptoms, the signs are not visible to the eye and patients will have 20/20 vision. The only way to detect NPDR is by fundus photography, in which microaneurysms (microscopic blood-filled bulges in the artery walls) can be seen. If there is reduced vision, fluorescein angiography can be done to see the back of the eye. Narrowing or blocked retinal blood vessels can be seen clearly and this is called retinal ischemia (lack of blood flow). Macular edema in which blood vessels leak their contents into the macular regi Continue reading >>
The Use Of Statistical Methodology To Determine The Accuracy Of Grading Within A Diabetic Retinopathy Screening Programme.
1. Diabet Med. 2016 Jul;33(7):896-903. doi: 10.1111/dme.13053. Epub 2016 Jan 10. The use of statistical methodology to determine the accuracy of grading within a diabetic retinopathy screening programme. Oke JL(1), Stratton IM(2), Aldington SJ(2), Stevens RJ(1), Scanlon PH(2). (1)Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. (2)Gloucestershire Retinal Research Group, Gloucester, UK. AIMS: We aimed to use longitudinal data from an established screening programmewith good quality assurance and quality control procedures and a stablewell-trained workforce to determine the accuracy of grading in diabeticretinopathy screening.METHODS: We used a continuous time-hidden Markov model with five states toestimate the probability of true progression or regression of retinopathy and theconditional probability of an observed grade given the true grade(misclassification). The true stage of retinopathy was modelled as a function of the duration of diabetes and HbA1c .RESULTS: The modelling dataset consisted of 65 839 grades from 14 187 people. Themedian number [interquartile range (IQR)] of examinations was 5 (3, 6) and themedian (IQR) interval between examinations was 1.04 (0.99, 1.17) years. In total,14 227 grades (21.6%) were estimated as being misclassified, 10 592 (16.1%)represented over-grading and 3635 (5.5%) represented under-grading. There were1935 (2.9%) misclassified referrals, 1305 were false-positive results (2.2%) and 630 were false-negative results (11.0%). Misclassification of background diabeticretinopathy as no detectable retinopathy was common (3.4% of all grades) butrarely preceded referable maculopathy or retinopathy.CONCLUSION: Misclassification between lower grades of retinopathy is not uncommonbut is unlikely to lead to Continue reading >>
Diabetic Eye Screening Programme (also Known As Diabetic Retinopathy Screening)
Diabetic Eye Screening Programme (also known as Diabetic Retinopathy Screening) Diabetes is a common condition that affects approximately 4.7% of the population. Around 87,000 people (and increasing) in Northern Ireland have been diagnosed with the condition. That's approximately 1 in every 22 people. Diabetic eye screening is currently offered every year to patients aged 12 years and over. The only exception is people who have no light perception in either eye. The aim of screening is to reduce the possible complications of diabetic retinopathy, which can cause sight loss and blindness. It is among the most common causes of blindness in people of working age. If retinopathy is identified early - for example through screening - and treated appropriately, sight loss can be prevented in the majority of people with diabetes. The Diabetic Eye Screening Programme (DESP) Regional Centre is based in Forster Green Hospital, but screening is carried out across Northern Ireland at GP practices and static sites. Primary care practices have registers of patients with diabetes and this information is used to identify the people who need to be invited for screening. People eligible for screening will be invited at least once a year. The appointment booking office is at Belfast Trust and can be contacted on 028 9063 9599. The screening programme is currently being modernised.The current phase of this project is looking at the service delivery model for the programme and the options for change. The document below has been produced, which reviews the options available, and outlines their advantages and disadvantages. Screening coordinators are seeking the opinions of those involved or affected by the programme. If you would like to be included in this pre-consultation process, please c Continue reading >>
Prevalence Of Diabetic Retinopathy In Screening-detected Diabetes Mellitus: Results From The Gutenberg Health Study (ghs)
Abstract Individuals with type 2 diabetes mellitus may experience an asymptomatic period of hyperglycaemia, and complications may already be present at the time of diagnosis. We aimed to determine the prevalence of diabetic retinopathy in patients with newly diagnosed (screening-detected) type 2 diabetes. The Gutenberg Health Study is a population-based study with 15,010 participants aged between 35 and 74 years. We determined the weighted prevalence of diabetic retinopathy by assessing fundus photographs. Screening-detected type 2 diabetes was defined as an HbA1c concentration of 6.5% (47.5 mmol/mol) or more, no medical diagnosis of diabetes and no intake of insulin or oral glucose-lowering agents. Of 14,948 participants, 1377 (9.2%) had diabetes mellitus. Of these, 347 (25.2%) had newly diagnosed type 2 diabetes detected by the screening. Overall, the weighted prevalence of screening-detected type 2 diabetes was 2.1%. Fundus photos were evaluable for 285 (82.1%) participants with newly diagnosed diabetes. The weighted prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13.0%; 12% of participants had a mild non-proliferative diabetic retinopathy and 0.6% had a moderate non-proliferative diabetic retinopathy. Diabetic retinopathy was proliferative in 0.3%. No cases of severe non-proliferative diabetic retinopathy or diabetic maculopathy were found. Thirty (14.9%) of 202 and six (7.2%) of 83 individuals with and without concomitant arterial hypertension, respectively, had diabetic retinopathy (OR 2.54, 95% CI 1.06, 7.14). Visual acuity did not differ between individuals with and without diabetic retinopathy . In this large European study, the prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13%. Only a very small propo Continue reading >>
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Prevalence Of Diabetic Retinopathy At First Presentation To The Retinal Screening Service In The Greater Wellington Region Of New Zealand 20062015, And Implications For Models Of Retinal Screening
Prevalence of diabetic retinopathy at first presentation to the retinal screening service in the greater Wellington region of New Zealand 20062015, and implications for models of retinal screening 17th February 2017, Volume 130 Number 1450 The prevalence of diabetes by district health board (DHB) area in New Zealand is estimated to range from 4.17% to 8.35%.1 The Ministry of Health estimated 260,458 diagnosed cases of New Zealanders with diabetes as at December 2015,2 and projects an average annual growth rate of new diabetes diagnoses of 5% according to Diabetes Surveillance: population-based estimates and projections for New Zealand.3 Blindness due to diabetic retinopathy (DR) is the most common cause of newly reported cases of visual loss in working-age adults (2074 years of age),4,5 which has debilitating implications to daily living, as well as the ability to remain in the workforce. In New Zealand, approximately 2025% of people with diabetes have DR, with an estimated 12% requiring care from ophthalmology.6,7 The benefits of retinal screening in reducing the burden to society of sight-threatening (ST) diabetic eye disease and incidental non-diabetic eye disease are long established.8 However, there is ongoing discussion surrounding how to best carry out screening, and particularly, the point of referral from primary care (collaborative teams including technicians, nurses, general practitioners (GPs) and optometrists) to secondary care (ophthalmology).9 The three DHBs that make up the greater Wellington region are Wairarapa DHB (Masterton District, Carterton District, South Wairarapa District), Hutt Valley DHB (Upper Hutt City, Lower Hutt City), and Capital & Coast DHB (Kapiti Coast District, Porirua City, Wellington City). The greater Wellington region was estima Continue reading >>
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National Diabetic Retinal Screening Programme Is Globally Unique Putting The Focus On New Eye Screening For People With Diabetes (press Release)
National Diabetic Retinal Screening Programme is globally unique putting the focus on new eye screening for people with diabetes (Press Release) Today Diabetic RetinaScreen The HSE National Diabetic Retinal Screening Programme released its inaugural programme report providing screening statistics for the first two screening rounds of the programmes operation (2013 2015). The programme is Government-funded and offers free, annual screening and treatment of diabetic retinopathy, a common complication of the eye which affects many people across the country living with diabetes. The release of the report fittingly coincides with World Diabetes Week. Launching the report, the Minister for Health, Simon Harris TD, said 'This free screening and treatment programme is globally unique and I very much welcome the significant progress being made. For the 200,000 people in Ireland living with Diabetes, this programme can prevent sight loss by early detection and treatment if required. When fully implemented, it will halve the rates of blindness and vision loss due to diabetic retinopathy. I encourage all individuals with Diabetes to avail of this service. Mr. Charles O Hanlon Head of the National Screening Service said that the objective of the Diabetic RetinaScreen programme is to reduce the risk of sight loss from diabetic retinopathy. What makes the HSE National Diabetic Retinal Screening Programme in Ireland unique is having an integrated treatment component and electronic medical records system which allows visibility of the patients through the entirety of their care pathway. Mr. David Keegan, Clinical Director of the Programme said that Diabetic RetinaScreen has already started to deliver positive results for diabetic patients in Ireland. We are detecting pre-symptomatic di Continue reading >>
Eye Screening Linked To Fall In Sight Loss In People With Diabetes
Eye screening linked to fall in sight loss in people with diabetes "The proportion of diabetics who go blind or suffer sight loss has almost halved since a new national retinopathy screening programme started in 2007," BBC News reports. The screening programme was in fact launched in 2003 but rolled out to all diabetic people over the age of 12 by 2007. The main risk to vision for people with diabetes is diabetic retinopathy , a condition where high blood sugar levels damage the retina, leading to sight loss and even blindness. Because of this, an NHS screening programme for people with diabetes in England and Wales was launched in 2003. This latest study looked at patient data from Wales to assess whether the programme had been successful in preventing cases of sight loss arising from diabetic retinopathy. Results suggest that it has been. The number and rate of people with diabetes who went on to have a Certificate of Visual Impairment decreased from 2008 to 2014. This shows the potential of screening for diabetic retinopathy to prevent future sight loss, but detailed interpretation of the results is difficult without data from before the screening programme. The reduction could also be down to other factors, such as general increased awareness of diabetes and improvements in care. If you have diabetes, whether type 1 or type 2, it's important to get your eyes checked once a year. If you haven't received a letter inviting you to a screening appointment in the past year, contact your GP. The study was carried out by researchers from Swansea University, Cardiff University, Cardiff and Vale University Health Board, Moorfields Eye Hospital and King's College London, all in the UK. The authors did not declare any competing interests. It was funded by the Wales School of P Continue reading >>
Diabetic Eye Screening
Diabetic eye screening is a key part of diabetes care. People with diabetes are at risk of damage from diabetic retinopathy, a condition that can lead to sight loss if it's not treated. Diabetic retinopathy is one of the most common causes of sight loss among people of working age. It occurs when diabetes affects small blood vessels, damaging the part of the eye called the retina. When the blood vessels in the central area of the retina (the macula) are affected, it's known as diabetic maculopathy. People with diabetes should also see their optician every two years for a regular eye test. Diabetic eye screening is specifically for diabetic retinopathy and can't be relied upon for other conditions. Why eye screening is needed Screening is a way of detecting the condition early before you notice any changes to your vision. Diabetic retinopathy doesn't usually cause any noticeable symptoms in the early stages. If retinopathy is detected early enough, treatment can stop it getting worse. Otherwise, by the time symptoms become noticeable, it can be much more difficult to treat. This is why the NHS Diabetic Eye Screening Programme was introduced. Everyone aged 12 and over with diabetes is offered screening once a year. Diabetic retinopathy is extremely unusual in children with diabetes who are under the age of 12. The check takes about half an hour and involves examining the back of the eyes and taking photographs of the retina. When diabetic eye screening is offered Everyone with diabetes who is 12 years of age or over should be invited to have their eyes screened once a year. You should receive a letter from your local Diabetic Eye Screening Service inviting you to attend a screening appointment. The letter will include a leaflet about diabetic eye screening. People with di Continue reading >>
Diabetic Retinal Screening, Grading, Monitoring And Referral Guidance
Diabetic Retinal Screening, Grading, Monitoring and Referral Guidance New Zealand already has a variety of local diabetic retinopathy screening services, some of which are very effective. The updated standards for grading, referral and monitoring set out in this guidance document recognise that some established programmes will have to adjust their processes and also that technology is quickly evolving. As a result this guidance aims to promote further convergence of regional services thereby reducing variation and providing a national benchmark. The guidance outlines the key components of an organised diabetic retinal screening service so that high-quality, equitable screening can be provided for all those at risk of diabetic eye disease. It represents a statement of best practice, based on stakeholder consultation, evidence and is intended to guide the delivery of a nationally consistent programme. There are strong links with the New Zealand Primary Care Handbook 2012 (updated 2013), the Quality Standards for Diabetes Care 2014 and Living Well with Diabetes 2015. Although the emphasis is on type 2 diabetes, pregnancy, children and adults with type 1 diabetes are also addressed to ensure they have the support of an organised retinal screening programme. Continue reading >>
