Trends in diabetic retinopathy screening attendance and associations with vision impairment attributable to diabetes in a large nationwide cohort

Abstract

Aims To investigate diabetic retinopathy screening attendance and trends in certified vision impairment caused by diabetic eye disease. Methods This was a retrospective study of attendance in three urban UK diabetic eye screening programmes in England. A survival analysis was performed to investigate time from diagnosis to first screen by age and sex. Logistic regression analysis of factors influencing screening attendance during a 15‐month reporting period was conducted, as well as analysis of new vision impairment certifications (Certificate of Vision Impairment) in England and Wales from 2009 to 2019. Results Of those newly registered in the Routine Digital Screening pathway (n = 97 048), 80% attended screening within the first 12 months and 88% by 36 months. Time from registration to first eye screening was longer for people aged 18–34 years, and 20% were unscreened after 3 years. Delay in first screen was associated with increased risk of referable retinopathy. Although 95% of participants (n = 291 296) attended during the 15‐month reporting period, uptake varied considerably. Younger age, social deprivation, ethnicity and duration of diabetes were independent predictors of non‐attendance and referable retinopathy. Although the last 10 years has seen an overall reduction in vision impairment certification attributable to diabetic eye disease, the incidence of vision impairment in those aged <35 years was unchanged. Conclusions Whilst the majority of participants are screened in a timely manner, there is considerable variation in uptake. Young adults, have sub‐optimal attendance, and levels of vision impairment in this population have not changed over the last 10 years. There is an urgent need to explore barriers to/enablers of attendance in this group to inform policy initiatives and tailored interventions to address this issue.

Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study

“…A study that aimed to provide estimates of visual impairment (including DR) among people attending DR screening in the UK in 2012, showed that South Asians (OR 1.10, 95% CI 1.02 to 1.18) and Black ethnic groups (OR 1.79, 95CI 1.70 to 1.89) have higher prevalence of visual impairment compared to White groups [ 25 ]. Another study from the UK on DR screening has identified younger age, social deprivation, ethnicity and duration of diabetes as independent risk factor of non-attendance, and referable retinopathy confirmed the same association of increase risk of referable DR among Asians (OR 1.57, 95%CI 1.43 to 1.72) and Black (OR 1.65, 95% CI 1.49–1.83) ethnic groups compared to White groups even after adjusting for age, gender, deprivation, diabetes duration and type [ 26 ]. All these findings suggest that extra efforts should be made to identify and treat STDR in these ethnic groups and to ensure that recording of self-reported ethnic group is implemented.…”

Characteristics of repeat non‐attenders at Diabetes Eye Screening Wales, a national community‐based diabetes‐related retinopathy screening service, during 2003‐2018

“…Younger age and living in higher deprivation areas have previously been identified as risk factors for non‐attendance at eye screening in people with diabetes 6,8,14,25 . A diabetic retinopathy screening programme in England is currently evaluating an education programme delivered in paediatric diabetes clinics to address this problem 26 .…”

“…A high coverage is vital to reduce unnecessary visual loss and blindness due to diabetes; the current uptake rates in England and Wales are relatively stable at approximately 80% 6,7 . Factors known to inhibit attendance at diabetic retinopathy screening include younger age, a lower socio‐economic status, type of diabetes, age, ethnicity and poor glycaemic control 6‐14 . In addition, confusion between screening and standard eye tests, relevance of screening despite no visual symptoms, fear of screening (e.g.…”

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

“…Although uptake of screening is generally high (eg, 82.6% for England in 2018/2019), this overall figure masks variable uptake between regional programs and suboptimal attendance in particular demographic groups (eg, adults aged <35 years, mixed ethnicity groups, lower socioeconomic status groups). [5][6][7] A recent retrospective analysis of attendance in three large urban screening programs in England serving a population of over 300 000 people with diabetes found that uptake rates were lowest among those aged 18-34 years. The odds of attending screening in this group were significantly less than the reference group of participants aged over 60, after controlling for other demographic variables (age, sex, ethnicity and socioeconomic deprivation).…”