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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1998 Jan;52(1):45–52. doi: 10.1136/jech.52.1.45

Impact of diabetic retinopathy screening on a British district population: case detection and blindness prevention in an evidence- based model

M O Bachmann, S J Nelson
PMCID: PMC1756614  PMID: 9604041

Abstract

OBJECTIVES: To quantify case detection and blindness prevention attainable through screening for diabetic retinopathy in a district population. DESIGN: Literature review including a pooled estimate of screening test sensitivity, and quantitative modelling, including sensitivity analyses. SETTING AND PATIENTS: The diabetic population of a typical district health authority or health board. MAIN RESULTS: Evidence suggests that in a British general practice based diabetic population, prevalence of retinopathy requiring treatment would be between 1% and 6%; annual incidence of blindness among diabetics with retinopathy requiring treatment would be between 6% and 9%; sensitivity of screening tests in detecting retinopathy requiring treatment would be between 50% and 88%; and treatment could prevent 77% of expected cases of blindness. Of those screened, about 4% would be correctly detected as requiring treatment during an initial screening round, but this yield could decrease to about 1% in subsequent annual screening rounds. Of those treated, about 6% would be prevented from going blind within a year of treatment and 34% within 10 years of treatment. CONCLUSIONS: Screening and early treatment of diabetic retinopathy can prevent substantial disability. The effectiveness and efficiency of screening could be enhanced by improving the performance of current tests or increasing use of mydriatic retinal photography, and by increasing uptake, particularly among diabetics at greatest risk.

 

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Selected References

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  1. Awh C. C., Cupples H. P., Javitt J. C. Improved detection and referral of patients with diabetic retinopathy by primary care physicians. Effectiveness of education. Arch Intern Med. 1991 Jul;151(7):1405–1408. [PubMed] [Google Scholar]
  2. Benett I. J., Lambert C., Hinds G., Kirton C. Emerging standards for diabetes care from a city-wide primary care audit. Diabet Med. 1994 Jun;11(5):489–492. doi: 10.1111/j.1464-5491.1994.tb00312.x. [DOI] [PubMed] [Google Scholar]
  3. Bennett S., Woods T., Liyanage W. M., Smith D. L. A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat Q. 1991;44(3):98–106. [PubMed] [Google Scholar]
  4. Burnett S. D., Woolf C. M., Yudkin J. S. Developing a district diabetic register. BMJ. 1992 Sep 12;305(6854):627–630. doi: 10.1136/bmj.305.6854.627. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Buxton M. J., Sculpher M. J., Ferguson B. A., Humphreys J. E., Altman J. F., Spiegelhalter D. J., Kirby A. J., Jacob J. S., Bacon H., Dudbridge S. B. Screening for treatable diabetic retinopathy: a comparison of different methods. Diabet Med. 1991 May;8(4):371–377. doi: 10.1111/j.1464-5491.1991.tb01612.x. [DOI] [PubMed] [Google Scholar]
  6. Dasbach E. J., Fryback D. G., Newcomb P. A., Klein R., Klein B. E. Cost-effectiveness of strategies for detecting diabetic retinopathy. Med Care. 1991 Jan;29(1):20–39. doi: 10.1097/00005650-199101000-00003. [DOI] [PubMed] [Google Scholar]
  7. Forrest R. D., Jackson C. A., Yudkin J. S. Screening for diabetic retinopathy--comparison of a nurse and a doctor with retinal photography. Diabetes Res. 1987 May;5(1):39–42. [PubMed] [Google Scholar]
  8. Harding S. P., Broadbent D. M., Neoh C., White M. C., Vora J. Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool Diabetic Eye Study. BMJ. 1995 Oct 28;311(7013):1131–1135. doi: 10.1136/bmj.311.7013.1131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Howitt A. J., Cheales N. A. Diabetes registers: a grassroots approach. BMJ. 1993 Oct 23;307(6911):1046–1048. doi: 10.1136/bmj.307.6911.1046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hurwitz B., Goodman C., Yudkin J. Prompting the clinical care of non-insulin dependent (type II) diabetic patients in an inner city area: one model of community care. BMJ. 1993 Mar 6;306(6878):624–630. doi: 10.1136/bmj.306.6878.624. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Irwig L., Macaskill P., Glasziou P., Fahey M. Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol. 1995 Jan;48(1):119–132. doi: 10.1016/0895-4356(94)00099-c. [DOI] [PubMed] [Google Scholar]
  12. Javitt J. C., Canner J. K., Frank R. G., Steinwachs D. M., Sommer A. Detecting and treating retinopathy in patients with type I diabetes mellitus. A health policy model. Ophthalmology. 1990 Apr;97(4):483–495. doi: 10.1016/s0161-6420(90)32573-3. [DOI] [PubMed] [Google Scholar]
  13. Javitt J. C., Canner J. K., Sommer A. Cost effectiveness of current approaches to the control of retinopathy in type I diabetics. Ophthalmology. 1989 Feb;96(2):255–264. doi: 10.1016/s0161-6420(89)32923-x. [DOI] [PubMed] [Google Scholar]
  14. Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. IX. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol. 1989 Feb;107(2):237–243. doi: 10.1001/archopht.1989.01070010243030. [DOI] [PubMed] [Google Scholar]
  15. Klein R., Klein B. E., Moss S. E., Davis M. D., DeMets D. L. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. IX. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol. 1989 Feb;107(2):237–243. doi: 10.1001/archopht.1989.01070010243030. [DOI] [PubMed] [Google Scholar]
  16. Klein R., Klein B. E., Moss S. E. The Wisconsin epidemiologic study of diabetic retinopathy: an update. Aust N Z J Ophthalmol. 1990 Feb;18(1):19–22. doi: 10.1111/j.1442-9071.1990.tb00579.x. [DOI] [PubMed] [Google Scholar]
  17. Klein R., Klein B. E., Neider M. W., Hubbard L. D., Meuer S. M., Brothers R. J. Diabetic retinopathy as detected using ophthalmoscopy, a nonmydriatic camera and a standard fundus camera. Ophthalmology. 1985 Apr;92(4):485–491. doi: 10.1016/s0161-6420(85)34003-4. [DOI] [PubMed] [Google Scholar]
  18. Klein R., Moss S. E., Klein B. E., DeMets D. L. Relation of ocular and systemic factors to survival in diabetes. Arch Intern Med. 1989 Feb;149(2):266–272. [PubMed] [Google Scholar]
  19. Kristinsson J. K., Stefánsson E., Jónasson F., Gíslason I., Björnsson S. Screening for eye disease in type 2 diabetes mellitus. Acta Ophthalmol (Copenh) 1994 Jun;72(3):341–346. doi: 10.1111/j.1755-3768.1994.tb02770.x. [DOI] [PubMed] [Google Scholar]
  20. Kristinsson J. K., Stefánsson E., Jónasson F., Gíslason I., Björnsson S. Systematic screening for diabetic eye disease in insulin dependent diabetes. Acta Ophthalmol (Copenh) 1994 Feb;72(1):72–78. doi: 10.1111/j.1755-3768.1994.tb02741.x. [DOI] [PubMed] [Google Scholar]
  21. Leese G. P., Ahmed S., Newton R. W., Jung R. T., Ellingford A., Baines P., Roxburgh S., Coleiro J. Use of mobile screening unit for diabetic retinopathy in rural and urban areas. BMJ. 1993 Jan 16;306(6871):187–189. doi: 10.1136/bmj.306.6871.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lienert R. T. Inter-observer comparisons of ophthalmoscopic assessment of diabetic retinopathy. Aust N Z J Ophthalmol. 1989 Nov;17(4):363–368. doi: 10.1111/j.1442-9071.1989.tb00555.x. [DOI] [PubMed] [Google Scholar]
  23. Moss S. E., Klein R., Kessler S. D., Richie K. A. Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy. Ophthalmology. 1985 Jan;92(1):62–67. doi: 10.1016/s0161-6420(85)34082-4. [DOI] [PubMed] [Google Scholar]
  24. Moss S. E., Klein R., Klein B. E. The incidence of vision loss in a diabetic population. Ophthalmology. 1988 Oct;95(10):1340–1348. doi: 10.1016/s0161-6420(88)32991-x. [DOI] [PubMed] [Google Scholar]
  25. Pugh J. A., Jacobson J. M., Van Heuven W. A., Watters J. A., Tuley M. R., Lairson D. R., Lorimor R. J., Kapadia A. S., Velez R. Screening for diabetic retinopathy. The wide-angle retinal camera. Diabetes Care. 1993 Jun;16(6):889–895. doi: 10.2337/diacare.16.6.889. [DOI] [PubMed] [Google Scholar]
  26. Reenders K., de Nobel E., van den Hoogen H., van Weel C. Screening for diabetic retinopathy by general practitioners. Scand J Prim Health Care. 1992 Dec;10(4):306–309. doi: 10.3109/02813439209014079. [DOI] [PubMed] [Google Scholar]
  27. Rohan T. E., Frost C. D., Wald N. J. Prevention of blindness by screening for diabetic retinopathy: a quantitative assessment. BMJ. 1989 Nov 11;299(6709):1198–1201. doi: 10.1136/bmj.299.6709.1198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Sculpher M. J., Buxton M. J., Ferguson B. A., Spiegelhalter D. J., Kirby A. J. Screening for diabetic retinopathy: a relative cost-effectiveness analysis of alternative modalities and strategies. Health Econ. 1992 Apr;1(1):39–51. doi: 10.1002/hec.4730010107. [DOI] [PubMed] [Google Scholar]
  29. Simmons D., Williams D. R., Powell M. J. The Coventry Diabetes Study: prevalence of diabetes and impaired glucose tolerance in Europids and Asians. Q J Med. 1991 Dec;81(296):1021–1030. doi: 10.1093/qjmed/81.3.1021. [DOI] [PubMed] [Google Scholar]
  30. Singer D. E., Nathan D. M., Fogel H. A., Schachat A. P. Screening for diabetic retinopathy. Ann Intern Med. 1992 Apr 15;116(8):660–671. doi: 10.7326/0003-4819-116-8-660. [DOI] [PubMed] [Google Scholar]
  31. Taylor R., Lovelock L., Tunbridge W. M., Alberti K. G., Brackenridge R. G., Stephenson P., Young E. Comparison of non-mydriatic retinal photography with ophthalmoscopy in 2159 patients: mobile retinal camera study. BMJ. 1990 Dec 1;301(6763):1243–1247. doi: 10.1136/bmj.301.6763.1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Taylor R. Practical community screening for diabetic retinopathy using the mobile retinal camera: report of a 12 centre study. British Diabetic Association Mobile Retinal Screening Group. Diabet Med. 1996 Nov;13(11):946–952. doi: 10.1002/(SICI)1096-9136(199611)13:11<946::AID-DIA245>3.0.CO;2-U. [DOI] [PubMed] [Google Scholar]
  33. Williams R., Nussey S., Humphry R., Thompson G. Assessment of non-mydriatic fundus photography in detection of diabetic retinopathy. Br Med J (Clin Res Ed) 1986 Nov 1;293(6555):1140–1142. doi: 10.1136/bmj.293.6555.1140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. van de Kar W., van der Velden H. G., van Weel C., van den Hoogen H. J., Deutman A. Diagnosing diabetic retinopathy by general practitioners and by a hospital physician. The use of fundus photos. Scand J Prim Health Care. 1990 Mar;8(1):19–23. doi: 10.3109/02813439008994924. [DOI] [PubMed] [Google Scholar]

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