Blindness in patients with diabetes who have been screened for eye disease

Abstract

Fundus photography has been shown to be a useful screening tool for the detection of diabetic retinopathy. In this paper the authors assess the incidence of blind and partially sighted registration due to diabetic eye disease in patients screened by a mobile fundus photography unit and identify the factors that contributed to loss of vision in the registered group.Methods A retrospective review of blind and partially sighted registrations between 1990 and 1995 was performed in a diabetic population screened by a mobile fundus photography unit in a region with a population of 390 000. The incidence of blind and partially sighted registration in the screened diabetic population was calculated.In the registered group, cause of visual loss, accuracy of photograph reporting, delay in laser treatment, adequacy of laser treatment and non-attendance rates at ophthalmic clinics were assessed.Results Of the 5390 patients screened by the mobile unit over 6 years, 68 (210 per 10 5 patient-years) were registered blind or partially sighted, but in only 17 patients (53 per 10 5 patient-years) was this as a result of diabetes. The factors contributing to loss of vision were found to be failure of laser treatment, rapidly progressive disease and poor patient attendance.Conclusions As the majority of visual impairment in patients with diabetes is not due to diabetic retinopathy, this has important implications for screening programmes and may make the St Vincent Declaration targets difficult to achieve. The rate of new blind and partially sighted registration due to diabetes in the screened population was low at 53 per 10 5 patient-years (95% confidence interval, 29-76).

The progress in understanding and treatment of diabetic retinopathy

“…Even with improved and more cost-effective strategies for screening of diabetic retinopathy, the challenge remains of assuring that all eligible individuals are reached and when so, that they remain engaged in the screening programmes to reduce the risk of non-attendance, which is closely associated with poorer long-term outcomes and increased prevalence of diabetic complications (Deckert et al, 1978a, b;Rhatigan et al, 1999). To this end, smart phone ophthalmoscope technology has been suggested to provide some value since these devices provide portability, affordability, and connectivity (Russo et al, 2015b).…”

The incidence of visual impairment due to diabetic retinopathy in Leeds

“…Failed laser treatment and poor patient attendance accounted for much of the visual impairment in diabetics who had been screened, suggesting that the screening exercise itself may have little impact on future visual impairment. 33 As with many UK centres, there was no diabetes register in Leeds during the study period. We therefore used the population prevalence model published by the Yorkshire and Humber Public Health Observatory to estimate the prevalence of diagnosed diabetes in Leeds.…”

Longitudinal study of a cohort of people with diabetes screened by the Exeter Diabetic Retinopathy Screening Programme

“…In addition, visual impairment due to diabetic retinopathy does not appear to be the major cause of severe visual loss in people with diabetes, especially those with Type II diabetes. 6 If blindness is too crude an outcome measure to usefully assess the impact of screening, alternative outcome indicators will have to be considered. Our aim is to examine some of these alternatives in this paper.…”