Diabetic Retinopathy Screening and Monitoring of Early Stage Disease in Australian General Practice: Tackling Preventable Blindness within a Chronic Care Model

Abstract

Introduction. Diabetic retinopathy (DR) is the leading cause of preventable blindness in Australia. Up to 50% of people with proliferative DR who do not receive timely treatment will become legally blind within five years. Innovative and accessible screening, involving a variety of primary care providers, will become increasingly important if patients with diabetes are to receive optimal eye care. Method. An open controlled trial design was used. Five intervention practices in urban, regional, and rural Australia partnered with ophthalmologists via telehealth undertook DR screening and monitoring of type 2 diabetes patients and were compared with control practices undertaking usual care 2011–2014. Results. Recorded screening rates were 100% across intervention practices, compared with 22–53% in control practices. 31/577 (5%) of patients in the control practices were diagnosed with mild-moderate DR, of whom 9 (29%) had appropriate follow-up recorded. This was compared with 39/447 (9%) of patients in the intervention group, of whom 37 (95%) had appropriate follow-up recorded. Discussion and Conclusion. General practice-based DR screening via Annual Cycle of Care arrangements is effective across differing practice locations. It offers improved recording of screening outcomes for Australians with type 2 diabetes and better follow-up of those with screen abnormalities.

Fundamental principles of an effective diabetic retinopathy screening program

“…Cuadros and Bresnick [39] noted that patients tend not to seek annual DR screening and suggested incorporating telemedicine screening into primary care practices; these authors applied EyePACS, a Web-based means of retinopathy grading. Results from an Australian study showed that general practice-based DR screening is effective, enabling improved recording of screening outcomes and facilitating better follow-up of patients with RDR [40]. In a review, Das et al [41] determined that DR is highly suitable for telemedicine because it saves time and minimizes lost income for the patient.…”

“…Potential barriers to screening include age (uptake rates are lowest in children and younger adults, and in older adults with reduced mobility) [91], geography [95], financial constraints or socioeconomic status [90,91,93] and lower education level [95]. DR screening via telemedicine is effective [35,36], can improve screening by reducing patient-perceived barriers to care [38,39,41], may improve follow-up [40] and appears to be cost-effective [37]. For any DR screening program to be effective, staff accreditation, appropriate IT infrastructure, continuing education and quality assurance procedures need to be in place and national standards should be followed [4,60].…”

Delivery of Eye and Vision Services in Aboriginal and Torres Strait Islander Primary Healthcare Centers

“…As retinal examinations largely rely on services being provided by visiting or off-site eye practitioners, utilizing retinal photo-screening integrated with primary care, image grading, and reporting systems may increase rates of examinations. This strategy has been shown to improve screening outcomes for other Australians with diabetes (25, 26). As we were unable to determine which centers used retinal imaging in this dataset, we could not investigate whether retinal imaging influences examinations rates.…”

How to perform better intervention to prevent and control diabetic retinopathy among patients with type 2 diabetes: A meta-analysis of randomized controlled trials

“…Diabetic retinopathy (DR), a microvascular complication of diabetes, is the leading cause of preventable blindness in working age population [1,2]. It is reported that after 20 years, nearly all patients with type 1 diabetes and more than 60% of those with type 2 diabetes will develop DR [3].…”