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Screening Finds Retinopathy Early in Diabetes

Posted: Tuesday, May 07, 2013

There was no significant decline in sight-threatening diabetic retinopathy (STDR) 4 years after the program was implemented among those getting screened for the first time. But among patients with no retinopathy on the first screen, the proportion with STDR at the second or later screen fell from 9.2% in 2008 to 3.2% in 2011 (P<0.001), researchers reported.

"Four years after the introduction of population-based, annual diabetic eye screening, patients who are at lower risk of STDR comprise a greater proportion of the screening population and may be suitable for less frequent screening," they wrote.

Annual retinopathy screening for diabetic patients has been implemented in England since 2008. Its aim is that all patients with diabetes are invited for eye screening within 3 months of their diagnosis.

To estimate the changes in the detection of retinopathy in the first 4 years of the program, Forster and colleagues looked at data on 32,340 patients with type 2 diabetes living in three London boroughs who had had at least one screen between 2008 and 2011. Patients had a total of 87,570 screens during that time. Participants identified as having STDR were referred for ophthalmologic care and treatment, and left the screening program.

The proportion of screens that were first-ever screens fell from 31.3% in 2008 to 15.4% in 2011. Among the 16,621 patients having their first-ever screens, the frequency of STDR was 7.1% in 2008, falling to 6.4% in 2011, but this was not a significant change.

More patients started getting second or later screens over the study period, with the proportion rising from 68.7% in 2008 to 74.6% in 2011. For those who didn't have retinopathy at first screen, the rate of STDR on the second or later screen fell from 9.2% in 2008 to 3.2% in 2011 (annual change -1.8%, P<0.001).

And for those who had mild non-proliferative retinopathy at first screen, the rate STDR at second screen or later declined from 21.6% in 2008 to 8.4% in 2011 (annual change -2.2%, P<0.001).

The decline in frequency of STDR among patients who had a second or later screen is most likely attributed to the fact that patients with existing STDR had been identified at the first screening, and so were removed from the eligible population.

Thus, lower-risk patients made up a larger fraction of the population for subsequent screening rounds, they wrote.

"Our findings provide further support to the argument for less frequent monitoring of patients who do not have retinopathy detected at [initial] screening," they wrote.

"Screening patients less frequently may increase the cost-effectiveness of diabetes eye screening programs," they concluded, noting that several American groups, particularly insurers, recommend screening every other year for patients with no retinopathy on the original screen.

Practice Pearls:

  • Point out that the results provide further support to the argument for less frequent monitoring of patients who do not have retinopathy detected on their initial screening.
  • A screening program for diabetic retinopathy eventually diminishes the likelihood of eye disease in patients with diabetes.

Source: http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=14569&catid=53&Itemid=8, Diabetes Care April 2013.

 
 
 
 
 
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