Quality-assured screening for diabetic retinopathy delivered in primary care in Ireland: an observational study

Abstract

BackgroundAt present, there is no national population-based retinopathy screening programme for people in Ireland who have diabetes, such as those operating in the UK for over a decade. AimTo evaluate a community-based initiative that utilised existing resources in general practice and community optometry/ophthalmology services to provide screening for diabetic retinopathy. Design and settingCross-sectional study using electronic ophthalmic patient screening records in community optometry clinics in Cork, Ireland. MethodA purposive sample of 32 practices was recruited from Diabetes in General Practice, a general practice-led initiative in the South of Ireland. Practices invited all adult patients registered with diabetes to participate in free retinopathy screening (n = 3598), provided by 15 community optometry practices and two community ophthalmologists. Data were recorded on an electronic database used by optometrists and the performance was benchmarked against proposed national standards for retinopathy screening. ResultsIn total, 30 practices participated (94%). After 6 months, 49% of patients (n = 1763) had been screened, following one invitation letter and no reminder. Forty-three per cent of those invited consented to their data being used in the study and subsequent analyses are based on that sample (n = 1542). The mean age of the patients screened was 65 years (standard deviation = 13.0 years), 57% were male (n = 884), and 86% had type 2 diabetes (n = 1320). In total, 26% had some level of retinopathy detected (n = 395); 21% had background retinopathy (n = 331), 3% had preproliferative retinopathy (n = 53), and 0.7% had proliferative retinopathy (n = 11). ConclusionThe detection of retinopathy among 26% of those screened highlights the need for a national retinopathy screening programme in Ireland. Significant learning, derived from the implementation of this initiative, will inform the national programme.

Systematic screening for diabetic retinopathy (DR) in Hong Kong: prevalence of DR and visual impairment among diabetic population

“…We found a high proportion of subjects with R1 who are at risk of progression to STDR 27. This highlights the need for screening in China, as in the West where population-based screening for DR has already been prioritised 28 29…”

Timing of access to secondary healthcare services and lower extremity amputations in patients with diabetes: a case–control study

“…Prior to the introduction of a national diabetic retinal screening programme in 2013, the delivery of diabetic retinopathy screening in Ireland was ad hoc. 29 30 Our counterintuitive finding may reflect a self-selection bias whereby patients who chose to seek out retinopathy screening may also actively manage their diabetes in ways that affect their LEA risk. Alternatively, their GPs may be more vigilant about their diabetes management resulting in more referral for retinopathy screening and less risk of LEA, perhaps by more referrals to podiatry services.…”

Fundamental principles of an effective diabetic retinopathy screening program

“…Another barrier to implementation of effective screening is delayed examination by a specialist. In a cross-sectional study in Ireland, 395 of 1542 patients were found to have some level of DR, and 11 had proliferative STDR [96]. Of these, 3 were given specialist appointments that were > 5 months from the original referral date [96].…”