Delay in diabetic retinopathy screening increases the rate of detection of referable diabetic retinopathy

Aims - To assess whether there is a relationship between delay in retinopathy screening after diagnosis of Type 2 diabetes and level of retinopathy detected. Methods - Patients were referred from 88 primary care practices to an English National Health Service diabetic eye screening programme. Data for screened patients were extracted from the primary care databases using semi-automated data collection algorithms supplemented by validation processes. The programme uses two-field mydriatic digital photographs graded by a quality assured team. Results - Data were available for 8183 screened patients with diabetes newly diagnosed in 2005, 2006 or 2007. Only 163 with Type 1 diabetes were identified and were insufficient for analysis. Data were available for 8020 with newly diagnosed Type 2 diabetes. Of these, 3569 were screened within 6 months, 2361 between 6 and 11 months, 1058 between 12 and 17 months, 366 between 18 and 23 months, 428 between 24 and 35 months, and 238 at 3 years or more after diagnosis. There were 5416 (67.5%) graded with no retinopathy, 1629 (20.3%) with background retinopathy in one eye, 753 (9.4%) with background retinopathy in both eyes and 222 (2.8%) had referable diabetic retinopathy. There was a significant trend (P = 0.0004) relating time from diagnosis to screening detecting worsening retinopathy. Of those screened within 6 months of diagnosis, 2.3% had referable retinopathy and, 3 years or more after diagnosis, 4.2% had referable retinopathy. Conclusions - The rate of detection of referable diabetic retinopathy is elevated in those who were not screened promptly after diagnosis of Type 2 diabetes

Can Protanopia Be Correctly Diagnosed in Clinical Practice? An Evaluation of Diagnosis by Four Screening Tests

SIGNIFICANCE Protanopia is a color vision deficiency (CVD) that is unacceptable for certain occupations. This study compares simultaneously for the first time the ability of three recently revised or developed clinical tests of color vision with the Ishihara test to diagnose protanopia from other color vision deficiencies. PURPOSE The objectives were to examine the ability of four clinical tests to differentiate (1) between protan and deutan CVDs in patients with protanopia and deuteranopia, and (2) protanopes and deuteranopes as “strong” deficiencies. METHODS The Hardy-Rand-Rittler (4th ed.), City University (3rd ed.), Ishihara, and Mollon-Reffin tests were evaluated against the Oculus Heidelberg Multi-Color anomaloscope for 18 protanopes and 9 deuteranopes. Diagnosis by anomaloscopy was subsequent to administration of screening tests. RESULTS The Ishihara test misdiagnosed all 18 protanopes as having a deutan deficiency. In contrast, the Hardy-Rand-Rittler and Mollon-Reffin tests correctly identified protan CVD in 100% of protanopes. No screening test was able to reliably diagnose protanopia on the basis of a strong protan CVD. CONCLUSIONS The Ishihara test is not suitable for screening for protanopia; its failure to diagnose protanopes as having a protan CVD was far greater than that in previous studies. The Hardy-Rand-Rittler and Mollon-Reffin are the most reliable tests for this purpose. None of the screening tests were able to reliably differentiate dichromacy from strongly anomalous trichromacy

Build to rent in London: a report for the University of New South Wales and NSW Landcom

At the invitation of the University New South Wales and NSW Landcom, LSE London carried out this study of the build to rent (BTR) sector in London, to help inform policy for the emerging market in Australia. The housing and rental markets in the UK and Australia share many features but London is about five years ahead of any Australian city in terms of BTR, and is therefore a natural comparator. In our research, which took place in the first half of 2018, we collected the latest statistics about BTR in London, reviewed recent publications, and interviewed 17 informed stakeholders. We also did a small survey of tenants, and conducted case studies of two recent BTR schemes

Update on Screening for Sight-Threatening Diabetic Retinopathy

The aim of this article was to describe recent advances in the use of new technology in diabetic retinopathy screening by looking at studies that assessed the effectiveness and cost-effectiveness of these technologies. METHODS: The author conducts an ongoing search for articles relating to screening or management of diabetic retinopathy utilising Zetoc with keywords and contents page lists from relevant journals. RESULTS: The areas discussed in this article are reference standards, alternatives to digital photography, area of retina covered by the screening method, size of the device and hand-held cameras, mydriasis versus non-mydriasis or a combination, measurement of distance visual acuity, grading of images, use of automated grading analysis and cost-effectiveness of the new technologies. CONCLUSIONS: There have been many recent advances in technology that may be adopted in the future by screening programmes for sight-threatening diabetic retinopathy but each device will need to demonstrate effectiveness and cost-effectiveness before more widespread adoption

Improving the screening of risk factors in diabetic retinopathy

Introduction: In 2002, Diabetic Retinopathy was reported as the leading cause of blindness in the working age group. The introduction of systematic screening programs in the UK has reduced visual loss and blindness due to diabetic retinopathy, but it does still occur with catastrophic consequences for the individual. Areas covered: The author conducted an ongoing search for articles relating to diabetic retinopathy since 2000 utilizing Zetoc Alert with keywords and contents page lists from relevant journals. This review covers the risk factors for loss of vision due to diabetic retinopathy and discusses ways in which the awareness of these risk factors can be used to further reduce visual loss. Some risk factors such as glycemic and B/P control are well known from landmark trials. This review has included these factors but concentrated more on the evidence behind those risk factors that are not so clearly defined or so well known. Expert opinion: The major risk factors are well known, but one continues to find that people with diabetes lose vision in situations in which a better awareness of the risks by both the individual with diabetes and the health workers involved may have prevented the visual loss

The English National Screening Programme for diabetic retinopathy 2003–2016

The aim of the English NHS Diabetic Eye Screening Programme is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process. In order to achieve the delivery of evidence-based, population-based screening programmes, it was recognised that certain key components were required. It is necessary to identify the eligible population in order to deliver the programme to the maximum number of people with diabetes. The programme is delivered and supported by suitably trained, competent, and qualified, clinical and non-clinical staff who participate in recognised ongoing Continuous Professional Development and Quality Assurance schemes. There is an appropriate referral route for those with screen-positive disease for ophthalmology treatment and for assessment of the retinal status in those with poor-quality images. Appropriate assessment of control of their diabetes is also important in those who are screen positive. Audit and internal and external quality assurance schemes are embedded in the service. In England, two-field mydriatic digital photographic screening is offered annually to all people with diabetes aged 12 years and over. The programme commenced in 2003 and reached population coverage across the whole of England by 2008. Increasing uptake has been achieved and the current annual uptake of the programme in 2015–16 is 82.8% when 2.59 million people with diabetes were offered screening and 2.14 million were screened. The benefit of the programme is that, in England, diabetic retinopathy/maculopathy is no longer the leading cause of certifiable blindness in the working age group

Screening Intervals for Diabetic Retinopathy and Implications for Care

Purpose of Review The purpose of this study is to review the evidence that lower risk groups who could safely be screened less frequently for sight-threatening diabetic retinopathy (DR) than annually. Recent Findings Data have demonstrated that people with no DR in either eye are at a low risk of progression to sight-threatening DR over a 2-year period (event rate 4.8 per 1000 person years), irrespective of whether the screening method is one-field non-mydriatic or two-field mydriatic digital photography. Low risk has been defined as no retinopathy on two consecutive screening episodes or no retinopathy on one screening episode combined with risk factor data. Summary The risk of an extension to 2 years is less than 5 per 1000 person years in a population with a national screening programme, and the general standard of diabetes care is relatively good, whether low risk is defined as no retinopathy on two consecutive screening episodes or no retinopathy on one screening episode combined with other risk factor data. The definition used in different populations is likely to depend on the availability of data