Is it safe to discharge treated proliferative diabetic retinopathy patients from the hospital eye service to a community screening programme?

Abstract

Purpose To investigate the distribution of new vessels (NV) in patients treated with pan-retinal photocoagulation for proliferative diabetic retinopathy (PDR). To assess whether it is safe to discharge treated PDR patients to the NHS Diabetic Eye Screening Programme (DESP) which uses two mydriatic 451 fields of each eye. Methods Consecutive treated PDR patients undergoing fundus fluorescein angiography between July 2010 and October 2011 for the purpose of looking for NV were included. The distribution of NV was mapped. In particular it was noted whether NV occurred in the area covered by the DESP standard screening images. Results A total of 76 patients (108 eyes) met the inclusion criteria for the study. Leaking NV were found inside the DESP fields in 89% of study patients. In 108 eyes with leaking NV, there were a total of 35 NVD and 336 NVE. NV were found within DESP fields in 83% of eyes. Of the 336 NVE, 54% occurred within and 46% outside DESP standard fields. There was no statistically significant difference in the retinal quadrant distribution of NVE. Conclusions If these findings apply to the whole treated PDR population, NVE would be identified in 89% of patients undergoing DESP screening. This would support stable treated PDR patients being monitored within the DESP. We found no preferential clustering of NV within quadrants or between posterior and less posterior retina suggesting that there would be no benefit to the DESP of taking an additional field or graders concentrating on one particular quadrant more than another.

Management of acute proliferative diabetic retinopathy related complications during the first COVID-19 wave

“…HES have access to wide field fundus imaging, whereas, DRS use two 45-degree field images. Negretti et al observed 108 eyes and found that 17% of NVE were outside of the DRS imaging fields and 11% of patients with active PDR would have been missed [ 23 ]. However, despite DRS not having 100% sensitivity it is considered a safe and effective screening tool to detect PDR.…”

Management of Acute Proliferative Diabetic Retinopathy Related Complications During the First COVID-19 Wave

“…HES have access to wide eld fundus imaging, whereas, DRS use two 45-degree eld images. Negretti et al observed 108 eyes and found that 17% of NVE were outside of the DRS imaging elds and 11% of patients with active PDR would have been missed 7 . However, despite DRS not having 100% sensitivity it is considered a safe and effective screening tool to detect PDR.…”