Trends in yield and effects of screening intervals during 17 years of a large UK community‐based diabetic retinopathy screening programme

Misra, Aseema; Bachmann, Max; Greenwood, R.; Jenkins, CA; Shaw, Amanda; Barakat, O.; Flatman, M; Jones, Colin

doi:10.1111/j.1464-5491.2009.02820.x

Cited by 64 publications

(85 citation statements)

References 19 publications

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“…Another study of 1,322 patients with type 2 diabetes did not observe any patients developing severe non-proliferative or proliferative retinopathy by 3 year follow-up if they had no retinopathy at baseline [24]. Misra et al [12], examining a larger sample, found that patients were no more likely to have referable retinopathy or maculopathy if they were screened every 18-24 months compared with every 12-18 months. Our results suggest that those patients who miss 1 or more years of screening represent a high-risk group with a greater chance of re-attending having developed retinopathy.…”

Section: Characteristicmentioning

confidence: 99%

“…Around 79% of individuals invited for diabetic eye screening in England took up the offer of screening in 2010/2011 [4]. Patients who do not attend for screening have poorer HbA 1c and blood pressure control [7] and have been diagnosed with diabetes for longer [7,8], all of which are risk factors for developing retinopathy [8][9][10][11][12][13][14][15]. These observations suggest that patients who do not attend for eye screening might be at increased risk of diabetic eye disease.…”

Section: Introductionmentioning

confidence: 99%

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Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Forster

Forbes

Dodhia³

et al. 2013

Diabetologia

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Aims/hypothesis This study evaluated whether repeated nonattendance for diabetic eye screening is associated with the risk of sight-threatening diabetic retinopathy (STDR). Methods This was a cohort study of 6,556 residents with diabetes who were invited for screening between 2008 and 2011 in a population-based eye screening programme in inner London and who attended for their first-ever screen in 2008. The proportion of participants with STDR was evaluated in relation to the number of years in which screening was missed.Results The proportion of participants who did not attend screening decreased between 2009 and 2011 (annual reduction 1.6% [95% CI 0.9%, 2.3%]). The adjusted relative odds of STDR for 210 participants who did not attend two consecutive years of screening were 3.76 (95% CI 2.14, 6.61; p<0.001), compared with participants who were screened annually. In 605 participants with mild non-proliferative retinopathy at the first screen, the adjusted relative odds of developing proliferative or moderate to severe nonproliferative retinopathy were 5.72 (95% CI 7.43, 22.83; p=0.013) for 53 participants who missed two screens. Conclusions/interpretation Patients who do not attend diabetic eye screening are at increased risk of developing STDR. Tracing of non-attenders with evidence of established retinopathy should be an important fail-safe procedure.

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Section: Characteristicmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Forster

Forbes

Dodhia³

et al. 2013

Diabetologia

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“…The Scottish Intercollegiate Guidelines Network (SIGN) 21 reported that patients with diabetes with no detected retinopathy could be screened every 2 years, with all others being screened at least annually. There have been a number of studies [22][23][24][25] that have modelled the possible effect of moving from annual to 2-3-year intervals in patients with type 1 and type 2 diabetes using incidence data from screening programmes in Iceland, Liverpool and Norwich. In 2007, Olafsdottir and Stefansson 26 reported the 10-year experience of biennial eye screening in patients with diabetes without retinopathy from Iceland, concluding that this seems to be safe and effective.…”

Section: Introductionmentioning

confidence: 99%

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Scanlon

Aldington

Leal

et al. 2015

Health Technol Assess

106

167

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BackgroundThe English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.ObjectivesTo determine whether personalised screening intervals are cost-effective.DesignRisk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium–low, medium–high or high risk). The risk factor models were validated in other populations.SettingGloucestershire, Nottinghamshire, South London and East Anglia (all UK).ParticipantsPeople with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.Main outcome measuresPersonalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.ResultsData were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43 –48% while screening high-risk groups every 2 years was cost-effective with a probability of 55–59%.ConclusionsThe study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading.Study registrationIntegrated Research Application System project number 118959.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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“…Although improved management of risk factors and advances in treatment modalities for diabetic retinopathy have contributed to reducing the risk of blindness from this pathology [2][3][4], type 2 diabetes per se has been continuously increasing in Asian populations [5,6]. The report from the International Diabetes Federation estimated that people with diabetes in the Asian Pacific region will increase from 137 million in 2010 to 214 million by 2030 [7].…”

Section: Introductionmentioning

confidence: 99%

Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes: 8 year follow-up study of the Japan Diabetes Complications Study (JDCS)

et al. 2011

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Aims/hypothesis The aim of this study was to determine the incidence and progression rates of diabetic retinopathy and their associations in Japanese individuals with type 2 diabetes. Methods This is a part of the Japan Diabetic Complications Study (JDCS), a multi-centred randomised trial of type 2 diabetes patients aged 40-70 years with an 8 year followup. There were 1,221 patients without diabetic retinopathy at baseline; incidence of diabetic retinopathy was defined as the development of any diabetic retinopathy. There were 410 patients with mild non-proliferative diabetic retinopathy at baseline; progression of diabetic retinopathy was defined as the development of severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy.We used multivariate proportional Cox hazard models, and generalised additive models were also applied to identify potential threshold effect.

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Trends in yield and effects of screening intervals during 17 years of a large UK community‐based diabetic retinopathy screening programme

Abstract: Over time the risk of late diagnosis of STDR decreased, possibly attributable to earlier diagnosis of less severe retinopathy, decreasing risk factors and systematic screening. Screening intervals of up to 24 months should be considered for lower risk patients.

Cited by 64 publications

References 19 publications

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes: 8 year follow-up study of the Japan Diabetes Complications Study (JDCS)

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