Validation of a model to estimate personalised screening frequency to monitor diabetic retinopathy

Heijden, Amber A. W. A. van der; Walraven, Iris; Riet, Esther van ’t; Aspelund, Thor; Lund, Sigrún H.; Elders, Petra; Polak, B.C.P.; Moll, Annette C.; Keunen, Jan E.E.; Dekker, Joost; Nijpels, Giel

doi:10.1007/s00125-014-3246-4

Cited by 35 publications

(47 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Screening for diabetic eye disease should focus on subjects with poor diabetic control, co-existing diabetic complications and comorbidities. A study from the Netherlands has recently developed a promising model to determine and personalize the screening frequency and interval for diabetic retinopathy, which might help to identify those patients who are most likely to develop retinopathy and who need referral and timely examination by an eye care specialist [57]. Given the sharp rise in diabetes-related eye disease, screening for retinopathy performed by non-ophthalmology personnel using fundus photography could be a measure to reduce health care costs that needs empirical support [14].…”

Section: Discussionmentioning

confidence: 99%

“…However, physicians treating patients with diabetes are often not following guidelines to recommend annual comprehensive eye examination, often do not remind patients with diabetes to seek eye care, and do not refer diabetic patients to a qualified optometrist or ophthalmologist [21,53e55]. While the U.S. and UK are considering to extend the screening interval for those without preexisting diabetic eye disease and mild diabetes beyond the established one year interval [12,14,56,57], guidelines in Germany still recommend yearly examinations for all diabetic patients [10,11]. Screening for diabetic eye disease should focus on subjects with poor diabetic control, co-existing diabetic complications and comorbidities.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

Baumeister

Schomerus

Andersen

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

Baumeister

Schomerus

Andersen

et al. 2015

Nutrition, Metabolism and Cardiovascular Diseases

View full text Add to dashboard Cite

“…ROC analysis showed a fair performance, with 59% fewer visits than annual screening. Van der Heijden et al tested this model in an up-to-date prospective cohort of people with type 2 diabetes [25]. Of a total of 8303, 3319 met the eligibility criteria, with a mean of 53 months follow-up.…”

Section: Discussionmentioning

confidence: 99%

Individualised variable-interval risk-based screening for sight-threatening diabetic retinopathy: the Liverpool Risk Calculation Engine

et al. 2017

View full text Add to dashboard Cite

Aims/hypothesis Individualised variable-interval risk-based screening offers better targeting and improved costeffectiveness in screening for diabetic retinopathy. We developed a generalisable risk calculation engine (RCE) to assign personalised intervals linked to local population characteristics, and explored differences in assignment compared with current practice. Methods Data from 5 years of photographic screening and primary care for people with diabetes, screen negative at the first of > 1 episode, were combined in a purpose-built nearreal-time warehouse. Covariates were selected from a dataset created using mixed qualitative/quantitative methods. Markov modelling predicted progression to screen-positive (referable diabetic retinopathy) against the local cohort history. Retinopathy grade informed baseline risk and multiple imputation dealt with missing data. Acceptable intervals (6, 12, 24 months) and risk threshold (2.5%) were established with patients and professional end users. Results Data were from 11,806 people with diabetes (46,525 episodes, 388 screen-positive). Covariates with sufficient predictive value were: duration of known disease, HbA 1c , age, systolic BP and total cholesterol. Corrected AUC (95% CIs) were: 6 months 0.88 (0.83, 0.93), 12 months 0.90 (0.87, 0.93) and 24 months 0.91 (0.87, 0.94). Sensitivities/specificities for a 2.5% risk were: 6 months 0.61, 0.93, 12 months 0.67, 0.90 and 24 months 0.82, 0.81. Implementing individualised RCE-based intervals would reduce the proportion of people becoming screenpositive before the allocated screening date by > 50% and the number of episodes by 30%. Conclusions/interpretation The Liverpool RCE shows sufficient performance for a local introduction into practice before wider implementation, subject to external validation. This ap- A list of ISDR Study Group members is included in the electronic supplementary material (ESM).Electronic supplementary material The online version of this article (doi:10.1007/s00125-017-4386-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users. Diabetologia (2017) 60:2174-2182 DOI 10.1007 proach offers potential enhancements of screening in improved local applicability, targeting and cost-effectiveness.

show abstract

“…Other investigators have described patient-specific recommendations for retinopathy screening, 21 including some using multistate Markov models 22–24 and others comparing the cost-effectiveness of biannual and annual screening versus no screening. 25,26 Our final models used extensive empirical data to determine an efficient personalized visit schedule that was based only on the current retinal disease state and glycated hemoglobin level.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Dcct¹,

et al. 2017

View full text Add to dashboard Cite

BACKGROUND In patients who have had type 1 diabetes for 5 years, current recommendations regarding screening for diabetic retinopathy include annual dilated retinal examinations to detect proliferative retinopathy or clinically significant macular edema, both of which require timely intervention to preserve vision. During 30 years of the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, retinal photography was performed at intervals of 6 months to 4 years. METHODS We used retinal photographs from the DCCT/EDIC study to develop a rational screening frequency for retinopathy. Markov modeling was used to determine the likelihood of progression to proliferative diabetic retinopathy or clinically significant macular edema in patients with various initial retinopathy levels (no retinopathy or mild, moderate, or severe nonproliferative diabetic retinopathy). The models included recognized risk factors for progression of retinopathy. RESULTS Overall, the probability of progression to proliferative diabetic retinopathy or clinically significant macular edema was limited to approximately 5% between retinal screening examinations at 4 years among patients who had no retinopathy, 3 years among those with mild retinopathy, 6 months among those with moderate retinopathy, and 3 months among those with severe nonproliferative diabetic retinopathy. The risk of progression was also closely related to mean glycated hemoglobin levels. The risk of progression from no retinopathy to proliferative diabetic retinopathy or clinically significant macular edema was 1.0% over 5 years among patients with a glycated hemoglobin level of 6%, as compared with 4.3% over 3 years among patients with a glycated hemoglobin level of 10%. Over a 20-year period, the frequency of eye examinations was 58% lower with our practical, evidence-based schedule than with routine annual examinations, which resulted in substantial cost savings. CONCLUSIONS Our model for establishing an individualized schedule for retinopathy screening on the basis of the patient’s current state of retinopathy and glycated hemoglobin level reduced the frequency of eye examinations without delaying the diagnosis of clinically significant disease.

show abstract

Validation of a model to estimate personalised screening frequency to monitor diabetic retinopathy

Cited by 35 publications

References 22 publications

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

Individualised variable-interval risk-based screening for sight-threatening diabetic retinopathy: the Liverpool Risk Calculation Engine

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Contact Info

Product

Resources

About