Mark Cahill, Global Vision National Diabetic Retinopathy Screening Programme

Diabetic Retina Screen

Screening for Diabetic Retinopathy in Ireland

Mark Cahill MCh, FRCSI (Ophth)

Clinical Lead

Global Vision

The Eye

Retina - layer like wet tissue paper that lines the inside of the eye

Macula - Important central area of retina

What is Diabetic Retinopathy

5.6% of the Irish population have Diabetes – approximately 210,000 people

Diabetic Retinopathy is the term used for two different types of changes in the

retina which can affect your sight.

1. Proliferative Diabetic Retinopathy:

Fragile new blood vessels form in a gradual way on the surface of the retina.

2. Diabetic Macular Oedema:

Leaky blood vessels affect the macula, the important central part of the retina.

Proliferative Diabetic Retinopathy

Diabetic Macular Oedema

Anyone with Diabetes can develop Diabetic Retinopathy

Main risk factors:

Duration of disease

High blood sugars

High blood pressure

High blood cholesterol

Pregnancy (not gestational diabetes). Pregnancy in women with diabetes can worsen Diabetic Retinopathy

What are the symptoms of Diabetic Retinopathy?

There may be no symptoms or pain in the early stages of Diabetic Retinopathy

Symptoms include:

Blurred vision or any changes in your sight

Black spots or “floaters” that appear to float in your eye

Trouble with seeing things at the side of your sight

Early detection and treatment can help to avoid sight loss

How is Diabetic Retinopathy Detected?

Diabetic Retinopathy can be detected in two ways:

1. During a full eye exam

2. Digital Photographic Screening

Two photographs of each eye with specific dimensions

Stored using special software (Digital Healthcare)

3 step analysis by graders; supervised by Eye Doctor

Quality Assured (internal and external)

Regular eye tests for glasses do not replace Diabetic Retinopathy screening. It is important to have both

Compelling case for Diabetic Retinopathy screening

Diabetic Retinopathy

• # 1 Cause of blindness in people aged 18 – 65

• Incidence of 50 – 65 per 100,000 people with diabetes

•Based just on registered patients the State spends €4.8 m per year supporting people with diabetes related blindness (and an extra €600k on new cases each year)*

• Annual screening examinations can prevent blindness in 96% of cases

• Screening is extremely cost effective using the quality – adjusted life year (QALY) model

• Fulfils the Wilson and Jungner criteria for a screening programme

• Digital eye photographs and grading is the Gold standard

Role of screening

*Does not include all the indirect socio-economic costs associated with blindness

Diabetic Retina Screen-The National Diabetic Retinal Screening Programme

National Cancer Screening ServiceDr Margaret Morgan - Clinical Lead

Pat Cafferty - Programme ManagerLeahna Kelly – Programme Co-ordinator

Contract out Photography and Grading service to two Providers

Global VisionLeinster except Meath and Westmeath

Medical Imaging Rest of the country

(Competitive tender awarded in December 2012)

Client Journey

• Eligible Clients - 12+ with Diabetes Mellitus• Source of clients – Diabetes Register• Client consents with NCSS to join the programme• Client scheduled, screened (photographed) &

graded • Results to GP • Results to client• Onward referral to treatment(if applicable)• Contacted by treatment centre• Stays within hospital or returned for annual

screening

Our Service

• Scheduling & result communication services

• Digital screening with dilation

• 2 photos of each eye – one disc centred, one macula centred

• Grading services

• Slit Lamp examination for ungradeable clients

Global Vision

Screening (photography) locations: • Thomas Court Primary Care Centre, Dublin• Diabetes Ireland - Santry• VHI Swiftcare - Dundrum• Cedar Clinic, Portlaoise• Vista Clinic, Naas• Ayrfield Medical Centre, Kilkenny• Slaney Medical, Enniscorthy

Digital Photographic Screening - Colour Photos

Grading

• Images go through 3 stages of grading depending on findings

• Primary Grade – all Clients• Secondary Grade – all

disease positive clients and 10% of normal

• Arbitration Grade – only if difference between Primary & Secondary Grade

• Referral Outcome Grading – All Clients being referred to treatment (Ophthalmologist)

ResultsPatient:

– Normal: letter & annual recall– DR: referral to treatment letter– NDED: referral to treatment letter– Ungradeable: referral to

treatment letter

Grading Report:R (retinopathy) code

M (macular oedema) codeCertain non diabetic eye diseases

(NDED)

GP: grading report

Treatment Centre: grading report with timeline required for referral (urgent 2-4 weeks, routine 13-18 weeks)

Hospital Treatment referral centres

• The Mater Misericordiae Hospital

• The Royal Victoria Eye and Ear Hospital

• Waterford Regional Hospital

• Dedicated clinics (3-6 clinics per week)

Global Vision

First patient screened 11th March 2013

Global Vision TeamGraders & Photographers = 8

Ophthalmologists = 4Clinical Lead Mark CahillProgramme Ophthalmologist Pat McGettrick

Administration team & Service Leads = 3Programme Director Sinead O ConnorProgramme Manager Adele Dunne

IT Support = 1

Global Vision

Target population is 145,000

30% of target screening population will be invited this year

(3,200 to date, 300 per week)

70% of target screening population will be invited next year

Photography and Grading accreditation with Peter Scanlon and Steve Aldington in Gloucestershire NHS Trust

DRS patient information

Acknowledgements

National Cancer Screening Service

Heart of England Diabetic Retinopathy Screening Centre, Birmingham

Global Vision Photographers and Graders