The results of the screening of 3318 diabetic patients for sight-threatening diabetic retinopathy in three UK centres are reported. The aims of the study were to determine the extent of diabetic retinopathy in the screened population and to assess the relative effectiveness of different screening methods in appropriately referring cases from a diabetic population, in a context very close to a routine clinical service. Patients were assessed by ophthalmoscopic examination by an ophthalmological clinical assistant. The clinical assistants' referral grades formed the reference standard against which to assess the effectiveness of other screening methods including ophthalmoscopy by primary screeners who were general practitioners (GPs), ophthalmic opticians and hospital physicians, and the assessment by consultant ophthalmologists of non-mydriatic Polaroid fundus photography. The performance of primary screeners based on ophthalmoscopy ranged from a sensitivity of 0.41, with a specificity of 0.89, for one of the GP groups, to a sensitivity of 0.67, with a specificity of 0.96, for the hospital physician group. The performance of the non-mydriatic camera ranged from a sensitivity of 0.35, with a specificity of 0.95, to a sensitivity of 0.67, with a specificity of 0.98.
SUMMARYThis study was performed to assess the workload imposed by treatment for infertility on a retinopathy of prematurity (ROP) screening programme. We PATIENTS AND METHODSThe records of all babies born between August 1991and December 1994 who were screened for ROP in the Neonatal Unit for the hospital. and the records of their mothers, were reviewed. Details of the birth data and examination findings were recorded for all the babies screened, and the number of pregnanciesCorrespondence to: Mr M. McKibbin.
Aims To report the use of ketamine sedation as an alternative anaesthetic method for babies undergoing treatment for retinopathy of prematurity (ROP). Methods All babies who underwent treatment for ROP over a 2-year period were included in this study. The babies preoperative weight, medical condition, and ventilation status was recorded. Data were collected on their ventilation status pre-, intra-, and postprocedure. Any change in their cardiac or respiratory status during or in the subsequent 3 days following the treatment was noted. Results Eleven babies, 22 eyes, required treatment over this period. The procedure was well tolerated with only three babies having intraoperative complications, which all resolved spontaneously. Two babies had postoperative complications requiring additional ventilation. In no case was the procedure abandoned owing to anaesthetic complications. Conclusions The use of ketamine sedation allows the laser to be performed in a ward setting and avoids the potential risk of general anaesthesia and inter-and intra-hospital transfer. It has been found to produce few intra-or postoperative complications for the infant, while providing satisfactory conditions for the treatment of ROP.
Aims To assess the effect of assisted conception (AC) on retinopathy of prematurity (ROP) and ROP screening. Follow-up to the study by McKibbin et al.
The relative cost and cost-effectiveness of different methods of screening diabetic patients for sight-threatening retinopathy are assessed. The resource costs per screening visit, both to the health service and to patients, of ophthalmoscopic examination by primary screeners including general practitioners, hospital physicians, and ophthalmic opticians are estimated together with those of a similar screening test by ophthalmological clinical assistants. The total resource cost per screen of screening using non-mydriatic photography is also estimated. Using estimates of sensitivity, specificity, and prevalence generated in the screening of 3318 diabetic patients in three UK centres, the relative cost-effectiveness of screening methods is estimated in terms of their cost per true positive case detected. On the assumption that a patient makes a special trip for eye screening, the cost per true positive case detected for primary screeners ranges from 633 pounds for a GP-screened group in one centre to 1079 pounds for another GP-screened group in a second centre; the cost per true positive case detected of photography ranges from 497 pounds for a camera that is taken to general practices in one centre to 1546 pounds for a hospital-based camera. Relative cost-effectiveness changes if, in some contexts, the screening can take place without requiring an additional patient visit, and is strongly related to the relative sensitivity of the screening methods and to the prior probability (prevalence or incidence) of retinopathy in the diabetic population.
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