External validation of a risk assessment model to adjust the frequency of eye-screening visits in patients with diabetes mellitus

Soto-Pedre, Enrique; Piniés, Jose A.; Hernaez-Ortega, Maria C.

doi:10.1016/j.jdiacomp.2014.12.020

Cited by 20 publications

(37 citation statements)

References 21 publications

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“…The Retina Risk algorithm has been validated in several studies and found to be robust (Aspelund et al, 2011; van der Heijden et al 2014; Soto‐Pedre et al 2015; Lund et al 2016; Schreur et al 2019). Using the program in ophthalmic practice, we did not experience any harm or delay in diagnosis to patients.…”

Section: Discussionmentioning

confidence: 99%

Diabetic eye screening with variable screening intervals based on individual risk factors is safe and effective in ophthalmic practice

Estil

Steinarsson²,

Einarsson³

et al. 2020

Acta Ophthalmologica

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Purpose: To test in a 'real world' diabetic eye-screening programme, a computer-based personal risk evaluation for progression to sight-threatening diabetic retinopathy. Screening intervals were individualized, and clinical outcomes, safety and cost-effectiveness documented. Methods: The RETINARISK algorithm was used in an ophthalmology clinic in Norway. The diabetes cohort was divided on voluntary basis into two groups: one with variable screening intervals based on their personal risk profile and the other group with conventional fixed interval diabetic eye screening. Compliance, clinical outcomes, safety and health economics were evaluated. A total of 843 diabetic patients participated in the program 2014-2019. A total of 63 had type 1 and 780 type 2 diabetes. A total of 671 patients had no diabetic retinopathy at baseline and 171 had retinopathy. Results: A total of 444 (53%) diabetic patients were included in the personal risk profile program and 399 in the fixed interval group. The RETINARISK algorithm calculated 563 screening intervals for the variable interval group, which was 23 AE 16 months (mean AE SD), compared to 14 AE 5 months for the group with fixed screening intervals. Due to selection bias, the two groups could not be directly compared. We did not experience any delay in detecting diabetic retinal changes when using the personal risk profile program. Conclusion: The RETINARISK algorithm was safe and effective in a diabetic screening program in an ophthalmology clinic over 5 years. The use of the program reduces the mean frequency of screening visits and liberates valuable time in ophthalmic practice to be used on high-risk diabetic patients or other patient groups.

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Section: Discussionmentioning

confidence: 99%

Diabetic eye screening with variable screening intervals based on individual risk factors is safe and effective in ophthalmic practice

Estil

Steinarsson²,

Einarsson³

et al. 2020

Acta Ophthalmologica

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“…The mathematical algorithm reliably predicts progression of diabetic retinopathy in the English cohort, as it did previously in Danish, 7 Dutch 8 and Spanish cohorts. 9 It identifies a relatively small group of high-risk patients based on clinical data, who need frequent screening, while a much larger group at low risk is well served with less frequent screening, which may reduce costs for health systems and patients alike.…”

Section: Discussionmentioning

confidence: 99%

“…This algorithm has been validated successfully in Denmark, 7 the Netherlands 8 and Spain. 9 It predicts about 80% of the risk of progression of diabetic retinopathy and recommends a screening interval according to individual risk. This allows reduction in mean screening frequency by over 50% (depending on interval ceiling) with corresponding reduction in costs.…”

Section: Introductionmentioning

confidence: 99%

Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs

et al. 2015

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ObjectiveTo validate a mathematical algorithm that calculates risk of diabetic retinopathy progression in a diabetic population with UK staging (R0–3; M1) of diabetic retinopathy. To establish the utility of the algorithm to reduce screening frequency in this cohort, while maintaining safety standards.Research design and methodsThe cohort of 9690 diabetic individuals in England, followed for 2 years. The algorithms calculated individual risk for development of preproliferative retinopathy (R2), active proliferative retinopathy (R3A) and diabetic maculopathy (M1) based on clinical data. Screening intervals were determined such that the increase in risk of developing certain stages of retinopathy between screenings was the same for all patients and identical to mean risk in fixed annual screening. Receiver operating characteristic curves were drawn and area under the curve calculated to estimate the prediction capability.ResultsThe algorithm predicts the occurrence of the given diabetic retinopathy stages with area under the curve =80% for patients with type II diabetes (CI 0.78 to 0.81). Of the cohort 64% is at less than 5% risk of progression to R2, R3A or M1 within 2 years. By applying a 2 year ceiling to the screening interval, patients with type II diabetes are screened on average every 20 months, which is a 40% reduction in frequency compared with annual screening.ConclusionsThe algorithm reliably identifies patients at high risk of developing advanced stages of diabetic retinopathy, including preproliferative R2, active proliferative R3A and maculopathy M1. Majority of patients have less than 5% risk of progression between stages within a year and a small high-risk group is identified. Screening visit frequency and presumably costs in a diabetic retinopathy screening system can be reduced by 40% by using a 2 year ceiling. Individualised risk assessment with 2 year ceiling on screening intervals may be a pragmatic next step in diabetic retinopathy screening in UK, in that safety is maximised and cost reduced by about 40%.

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“…In clinical practice, risk factors such as diabetes duration, HbA 1c levels, hypertension, and hyperlipidaemia are often considered alongside the classification when diagnosing or grading diabetic retinopathy. In some countries, such as Iceland and Sweden, these risk factors are used to determine screening frequency [10], and this approach has also been successfully piloted in the Netherlands, Spain, and Denmark [25][26][27]. These risk factors may be relevant for determining the risk of initial diabetic retinopathy development, but they do not explain the highly variable progression of non-proliferative retinopathy; however, baseline severity of diabetic retinopathy continues to predict clinical outcomes: Sato et al [8] reported that 35% of people with moderate nonproliferative retinopathy developed proliferative diabetic retinopathy within 2 years, whereas people with mild nonproliferative retinopathy did not.…”

Section: Risk Factors and Diabetic Retinopathymentioning

confidence: 99%

The unmet need for better risk stratification of non‐proliferative diabetic retinopathy

Sivaprasad

Pearce

2018

Diabet. Med.

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Diabetic retinopathy is a common microvascular complication of diabetes and remains one of the leading causes of preventable blindness in working‐age people. Non‐proliferative diabetic retinopathy is the earliest stage of diabetic retinopathy and is typically asymptomatic. Currently, the severity of diabetic retinopathy is assessed using semi‐quantitative grading systems based on the presence or absence of retinal lesions. These methods are well validated, but do not predict those at high risk of rapid progression to sight‐threatening diabetic retinopathy; therefore, new approaches for identifying these people are a current unmet need. We evaluated published data reporting the lesion characteristics associated with different progression profiles in people with non‐proliferative diabetic retinopathy. Based on these findings, we propose that additional assessments of features of non‐proliferative diabetic retinopathy lesions may help to stratify people based on the likelihood of rapid progression. In addition to the current classification, the following measurements should be considered: the shape and size of lesions; whether lesions are angiogenic in origin; the location of lesions, including predominantly peripheral lesions; and lesion turnover and dynamics. For lesions commonly seen in hypertensive retinopathy, a detailed assessment of potential concomitant diseases is also recommended. We believe that natural history studies of these changes will help characterize these non‐proliferative diabetic retinopathy progression profiles and advance our understanding of the pathogenesis of diabetic retinopathy in order to individualize management of people with diabetic retinopathy.

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External validation of a risk assessment model to adjust the frequency of eye-screening visits in patients with diabetes mellitus

Cited by 20 publications

References 21 publications

Diabetic eye screening with variable screening intervals based on individual risk factors is safe and effective in ophthalmic practice

Diabetic eye screening with variable screening intervals based on individual risk factors is safe and effective in ophthalmic practice

Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs

The unmet need for better risk stratification of non‐proliferative diabetic retinopathy

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