A prospective study was performed on the quality of photographs produced by the non-mydriatic fundus camera used in a hospital-based screening programme for diabetic retinopathy. In 1 year 981 binocular patients were photographed. A photograph of acceptable quality was obtained from 90.5% of eyes and 84.4% of patients had an acceptable photograph of both eyes. The photograph of the second eye was more often unacceptable than that of the first. This tendency was significant in females (p = 0.0196) and when considering the sexes together (p = 0.0044), but not significant in males (p = 0.1042). Photographs of unacceptable quality were obtained significantly more often in patients aged over 55 years for both right and left eyes (p = 0.001). An overall improvement in photographic quality might be achieved by allowing full recovery of flash-induced pupil constriction before taking the second photograph and by dilating those aged over 55 years.

Retinopathy in subjects with Type 1 diabetes mellitus may reflect a generalized process of endothelial dysfunction, even in the absence of microalbuminuria.

T he American Diabetes Association (ADA) has recommended selective screening for gestational diabetes mellitus (GDM) (1). Pregnant women aged 25 years, who have normal body weight, no family history of diabetes, and are not members of an ethnic/racial group with a high prevalence of diabetes, are regarded as a low-risk group for GDM and need not be screened. The effect of selective screening guidelines has been investigated in Caucasian populations using a 100-g 3-h oral glucose tolerance test (OGTT) (2,3). We report here the effect of the selective screening protocol. A total of 9,471 pregnant women in Tianjin, China, took part in a universal screening program from December 1998 to December 1999. The screening test consisted of a 50-g 1-h glucose test and was carried out at 26-to 30-weeks' gestation. A total of 888 (9.4%) women had a glucose reading 7.8 mmol/l, of whom 701 undertook a further 75-g 2-h OGTT using the WHO diagnostic criteria for GDM (baseline: 7.0 mmol/l; 2-h: 7.8 mmol/l) (4). A total of 171 women were confirmed to have GDM (prevalence 1.8%). Age, prepregnancy BMI, and family history of diabetes were risk factors for GDM in this cohort. The prevalence of overweight (BMI 25 kg/m 2) was low (10%), and family history of diabetes was uncommon (8%). Furthermore, the one-child policy has resulted in a cohort of 98% (9,240/9,471) of nulliparas. Twenty eight percent of women were 25 years of age. The application of the ADA selective screening guideline in this study would exclude 24% (2,248/9,469) of women from the screening test. An estimated 12% of women with confirmed GDM under the WHO criteria would otherwise have been denied the opportunity for early detection. These findings differ substantially from reports using the ADA recommendations: exclusion of 10% of women in the screening and oversight of 4% of GDM women (3). We adopted a similar, although slightly later, approach to the initial screening (26-to 30-vs. 24-to 28-weeks' gestation) (1). The WHO diagnostic criteria have been shown to give a higher estimation of GDM prevalence (5,6) in comparison with the ADA criteria. However, the prevalence of GDM in our study population was low. As our subjects are deemed a high-risk group (of Asian backgrounds) under the ADA selective screening guidelines, the lack of other risk factors is an important determinant of GDM prevalence. The greater proportion of Chinese women with GDM who would fail to be identified using selective screening, compared with the proportion shown in other studies, is unlikely to be explained by either the delay in screening or the use of the WHO criteria. The low frequency of risk factors for GDM in this co-hort was associated with a low prevalence of GDM. However, young and lean women were not immune from the development of GDM. We conclude that if selective screening is to be considered in this population, different age and BMI cutoff points are required , and other risk factors for GDM (such as stature) may need to be considered for inclusion in any revised selective screening ...

Retinal photography using a non‐mydriatic fundus camera has been proposed as a means of screening for diabetic retinopathy. We describe a screening programme which uses this technique and is run by liaison between a Diabetic Day Unit and Ophthalmology Department within a District General Hospital. A 10‐month period of screening is reported during which time 639 patients were photographed. Of these, 110 patients (17.2%) were referred for clinical eye examination of which 100 attended (15.6%), 27 patients (4.2%) subsequently underwent laser retinal photocoagulation. Of these, 22 received focal treatment and five required panretinal photocoagulation, nine cases (1.4%) were submitted to fundus fluorescein angiography. In 12 patients (1.9%), non‐diabetic ocular disease was detected.

PurposeThe England screening service classification of diabetic retinopathy has strict, quality assured criteria to identify potential diabetic maculopathy termed ‘M1’. All new M1 cases identified by the screening service are referred to a hospital service. We aimed to evaluate the effectiveness of the England National Diabetic Eye Screening R1M1 classification of diabetic maculopathy as a criteria for secondary care referral in Portsmouth, UK.MethodsRetrospective audit of all patients referred to Portsmouth Hospitals NHS Trust with R1M1 pathology from April 2013 to January 2014. The total number of referrals received for this period was noted as well as the number of patients followed up in subsequent care pathways. Follow‐up data on those who remained under hospital care is presented for three years.ResultsA total of 306 diabetic patients were referred to Portsmouth Hospitals NHS Trust for R1M1 pathology over a 10 month period. At the first hospital appointment 135 (44%) had no fluid present on macular SD OCT and were either referred back to screening if the M1 features had resolved (65) or followed up with retinal images (70). 115 (38%) patients were considered to require further follow‐up in secondary care. Of those patients remaining in secondary care 70 remained in active follow up 3 years later.ConclusionsThese results would suggest that 44% of those with M1 features have no evidence of diabetic maculopathy on OCT at the initial hospital appointment and were discharged to community screening. Follow‐up for over three years in a secondary care setting is required by 23%. Secondary service could be better utilised by streamlining referrals either by refining the R1M1 classification or developing community based OCT service.