P H Scanlon

Gloucestershire Hospitals NHS Foundation Trust, Gloucester, England, United Kingdom

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Publications (34)129.26 Total impact

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    ABSTRACT: This study aimed to follow the natural progression of retinal changes in patients with diabetes. Such information should inform decisions with regard to the screening intervals for such patients. An observational study was undertaken linking the data from seven diabetes retinal screening programs across the U.K. for retinal grading results between 2005 and 2012. Patients with absent or background retinopathy were followed up for progression to the end points referable retinopathy and treatable retinopathy (proliferative retinopathy). In total 354,549 patients were observed for up to 4 years during which 16,196 patients progressed to referable retinopathy. Of patients with no retinopathy in either eye for two successive screening episodes at least 12 months apart, the conditions of between 0.3% (95% CI 0.3-0.8%) and 1.3% (1.0-1.6%) of patients progressed to referable retinopathy, and rates of treatable eye disease were <0.3% at 2 years. The corresponding progression rates for patients with bilateral background retinopathy in successive screening episodes were 13-29% and up to 4%, respectively, in the different programs. It may be possible to stratify patients for risk, according to baseline retinal criteria, into groups with low and high risk of their conditions progressing to proliferative retinopathy. Screening intervals for such diverse groups of patients could safely be modified according to their risk. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes Care 12/2014; 38(3). DOI:10.2337/dc14-1778 · 8.57 Impact Factor
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    ABSTRACT: To examine the experiences of patients, health professionals and screeners; their interactions with and understandings of diabetic retinopathy screening (DRS); and how these influence uptake. Purposive, qualitative design using multiperspectival, semistructured interviews and thematic analysis. Three UK Screening Programme regions with different service-delivery modes, minority ethnic and deprivation levels across rural, urban and inner-city areas, in general practitioner practices and patients' homes. 62 including 38 patients (22 regular-screening attenders, 16 non-regular attenders) and 24 professionals (15 primary care professionals and 9 screeners). Antecedents to attendance included knowledge about diabetic retinopathy and screening; antecedents to non-attendance included psychological, pragmatic and social factors. Confusion between photographs taken at routine eye tests and DRS photographs was identified. The differing regional invitation methods and screening locations were discussed, with convenience and transport safety being over-riding considerations for patients. Some patients mentioned significant pain and visual disturbance from mydriasis drops as a deterrent to attendance. In this, the first study to consider multiperspectival experiential accounts, we identified that proactive coordination of care involving patients, primary care and screening programmes, prior to, during and after screening is required. Multiple factors, prior to, during and after screening, are involved in the attendance and non-attendance for DRS. Further research is needed to establish whether patient self-management educational interventions and the pharmacological reformulation of shorter acting mydriasis drops, may improve uptake of DRS. This might, in turn, reduce preventable vision loss and its associated costs to individuals and their families, and to health and social care providers, reducing current inequalities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    BMJ Open 12/2014; 4(12):e005498. DOI:10.1136/bmjopen-2014-005498 · 2.06 Impact Factor
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    ABSTRACT: AimsTo examine the relationship between visual acuity in each eye and Quality of Life (QoL) outcomes in people with diabetic macular oedema.Methods Cross sectional retrospective analysis of data collected at baseline in 289 people entered into a randomized clinical trial with diabetic macular oedema which investigated the safety and efficacy of a vascular endothelial growth factor inhibitor, pegaptanib sodium. At the baseline visit, visual acuity was measured through refraction and using retro-illuminated modified Early Treatment Diabetic Retinopathy Study Log MAR charts, and patient health-related QoL was determined using the European Quality of Life EQ–5D–3L and the Visual Functioning Questionnaire–25 (NEI–VFQ 25). A regression analysis with QoL score from each vision-related domain as the dependent variable was fitted using linear and quadratic terms of the better and worse eye, age, gender, adjusted for number of concurrent conditions, ethnicity and level of diabetes control.ResultsFor all vision-related QoL domains from NEI–VFQ 25 and EQ–5D–3L except ocular pain, both visual acuity in the better-seeing and the worse-seeing eye gave a significant increase in correlation coefficient over that obtained from clinical and demographic data. The NEI–VFQ 25 correlation was most closely associated with a weighted visual acuity measure of 0.75 in the better and 0.25 in the worse eye or 0.60 in the better and 0.40 in the worse eye.Conclusions We recommend that a weighted visual acuity measure from both eyes is considered in future diabetic macular oedema trials.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 09/2014; DOI:10.1111/dme.12593 · 3.06 Impact Factor
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    ABSTRACT: Background The NHS Diabetic Eye Screening Programme aims to reduce the risk of sight loss among people with diabetes in England by enabling prompt diagnosis of sight-threatening retinopathy. However, the rate of screening uptake between practices can vary from 55% to 95%. Existing research focuses on the impact of patient demographics but little is known about GP practice-related factors that can make a difference. Aim To identify factors contributing to high or low patient uptake of retinopathy screening. Design and setting Qualitative case-based study; nine purposively selected GP practices (deprived/ affluent; high/ low screening uptake) in three retinopathy screening programme areas. Methods Semi-structured interviews were conducted with patients, primary care professionals, and screeners. A comparative case-based analysis was carried out to identify factors related to high or low screening uptake. Results Eight possible factors that influenced uptake were identified. Five modifiable factors related to service and staff interactions: communication with screening services; contacting patients; integration of screening with other care; focus on the newly diagnosed; and perception of nonattenders. Three factors were non-modifiable challenges related to practice location: level of deprivation; diversity of ethnicities and languages; and transport and access. All practices adopted strategies to improve uptake, but the presence of two or more major barriers made it very hard for practices to achieve higher uptake levels. Conclusions A range of service-level opportunities to improve screening attendance were identified that are available to practices and screening teams. More research is needed into the complex interfaces of care that make up retinopathy screening.
    British Journal of General Practice 08/2014; 64(625):e484-92. DOI:10.3399/bjgp14X680965 · 2.36 Impact Factor
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    ABSTRACT: Risk perception of diabetic retinopathy among people with type 2 diabetes Authors Al-Athamneh, N.; Sturt, J.; Dolan, A.; Lindenmeyer, A. ; Stratton, I.M. ; Scanlon, P.H. Aim To explore how the risk of Diabetic Retinopathy (DR) is understood by people with diabetes and Health Care Professionals (HCPs). Methods A qualitative study was conducted using semi-structured interviews with a convenience sample of 25 participants. Of these, 20 participants were diagnosed with type 2 diabetes (11 White British and 9 South Asians), and 2 primary care physicians, 2 ophthalmologists, and 1 retinal screener. Participants were purposely recruited to fall into 5 groups of 5 participants each. 1) No DR; 2): background DR; 3) preproliferative DR; 4) proliferative DR; 5) HCPs. Risk information about DR was routinely provided to participants by HCPs after annual diabetic screening. Results Participants with diabetes were unfamiliar with the term retinopathy, however they were aware that diabetes could lead to changes in their sight or to Sight Threatening Diabetic Retinopathy (STDR).They were unaware that these changes could lead to permanent vision loss. Participants were optimistic about their chance of developing STDR. They perceived the seriousness of risk based on noticeable symptoms and scores of visual acuity rather than grade of retinopathy. Knowledge of risk was even less with the symptomless participants. There was a huge difference in the risk perception between participants and HCPs; when HCPs communicated risk message as high risk of developing STDR (such as: the chance of developing STDR is 10 in 100 or 10%), participants perceived it as low or very low risk. Conclusion Risk information should be personalised, and provided in a clear and attractive style based on level of understanding, particularly to the symptomless participants. HCPs should assess patients’ knowledge and understanding of risk when risk message is given. Risk communication tools could benefit participants to understand their own risk of developing DR, and reduces anxiety level. More quantitative study should target the effectiveness of risk tools.
    EASDec 2014, Padova, Italy; 05/2014
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    British Journal of General Practice 01/2014; · 2.36 Impact Factor
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    ABSTRACT: Purpose: To examine the level of agreement and reasons for disagreement between grading of diabetic retinopathy and maculopathy using mydriatic digital photographs in a diabetic retinopathy screening service (DRSS) and hospital eye service (HES). Methods: English NHS Diabetic Eye Screening Programme grades for diabetic retinopathy prospectively recorded on a hospital electronic medical record were compared to the grades from the DRSS event that prompted referral. In cases of disagreement, images were reviewed. Results: Data for 1,501 patients (3,002 eyes) referred between 2008 and 2011 were analyzed. The HES retinopathy grades were R0 (no retinopathy) in 341 eyes, R1 (background retinopathy) in 1,712 eyes, R2 (pre-proliferative retinopathy) in 821 eyes, and R3 (proliferative retinopathy) in 128 eyes. The DRSS grades were in agreement in 2,309 eyes (76.9%), recorded a lower grade in 227 eyes, and recorded a higher grade in 466 eyes. Agreement was substantial (κ = 0.65). The commonest cause for disagreement was overgrading of R1 as R2 by hospital clinicians. The HES maculopathy grades were M0 (no maculopathy) in 2,267 eyes and M1 (maculopathy) in 735 eyes. The DRSS were in agreement in 2,111 eyes (70.2%), recorded a lower grade in 106 eyes, and recorded a higher grade in 785 eyes. Agreement was fair (κ = 0.39). The commonest cause for disagreement was hospital clinicians missing fine exudates. Conclusions: This study establishes a benchmark standard for agreement between HES and DRSS grading. Review of DRSS and grading reports images for newly referred patients is likely to improve levels of agreement, particularly for diabetic retinopathy, and should be strongly encouraged.
    European journal of ophthalmology 12/2013; DOI:10.5301/ejo.5000404 · 1.06 Impact Factor
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    ABSTRACT: There is currently an epidemic of diabetes in the world, principally type 2 diabetes that is linked to changing lifestyle, obesity, and increasing age of the population. Latest estimates from the International Diabetes Federation (IDF) forecasts a rise from 366 million people worldwide to 552 million by 2030. Type 1 diabetes is more common in the Northern hemisphere with the highest rates in Finland and there is evidence of a rise in some central European countries, particularly in the younger children under 5 years of age. Modifiable risk factors for progression of diabetic retinopathy (DR) are blood glucose, blood pressure, serum lipids, and smoking. Nonmodifiable risk factors are duration, age, genetic predisposition, and ethnicity. Other risk factors are pregnancy, microaneurysm count in an eye, microaneurysm formation rate, and the presence of any DR in the second eye. DR, macular edema (ME), and proliferative DR (PDR) develop with increased duration of diabetes and the rates are dependent on the above risk factors. In one study of type 1 diabetes, the median individual risk for the development of early retinal changes was 9.1 years of diabetes duration. Another study reported the 25 year incidence of proliferative retinopathy among population-based cohort of type 1 patients with diabetes was 42.9%. In recent years, people with diabetes have lower rates of progression than historically to PDR and severe visual loss, which may reflect better control of glucose, blood pressure, and serum lipids, and earlier diagnosis.
    Middle East African journal of ophthalmology 10/2013; 20(4):293-300. DOI:10.4103/0974-9233.120007
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    ABSTRACT: AimsTo report estimates of the prevalence of diabetic retinopathy (DR) and maculopathy grades for a large cohort of patients managed by the UK hospital eye service (HES).Methods Anonymised data were extracted from 30 UK NHS hospital trusts using a single ophthalmic electronic medical record (EMR) for the period from April 2000 to November 2010 to create the National Ophthalmology Database (NOD). From 2007, the EMR facilitated capture of a nationally agreed-upon standardised data set (DR Structured Assessment) relating to the presence or absence of clinical signs of DR and maculopathy. An algorithm in the software automatically calculated the Early Treatment of Diabetic Retinopathy Study grades of retinopathy and maculopathy.ResultsBetween 2007 and 2010, 307 538 patients had data on the NOD, with 76 127 (24.8%) patients having been recorded as having diabetes. The proportion of patients with diabetes who had a structured assessment increased from 50.7% (2007) to 86.8% (2010). In each NHS year, 12.6-20.6% of eyes with structured assessments had no DR; 59.6-67.3% had non-proliferative DR; and 18.3-20.9% had active or regressed proliferative DR. Clinically significant macular oedema was present in 15.8-18.1% of eyes, and in 8.7-10.0% of eyes, this involved the central macula.Conclusion This study provides contemporary estimates of the prevalence of retinopathy and maculopathy grades in a large cohort of patients with diabetes managed by the UK HES. Centre-involving diabetic macular oedema, potentially amenable to anti-VEGF therapy, is present in the eyes of almost 10% of these patients. This information is useful for clinicians, health-care economists, and commissioners involved in planning and delivering diabetic eye services.Eye advance online publication, 20 September 2013; (2013) 0, 000-000. doi:10.1038/eye.2013.196.
    Eye (London, England) 09/2013; 27(12). DOI:10.1038/eye.2013.196 · 1.90 Impact Factor
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    P H Scanlon, S J Aldington, I M Stratton
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    ABSTRACT: To assess whether there is a relationship between delay in retinopathy screening after diagnosis of Type 2 diabetes and level of retinopathy detected. 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. 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. The rate of detection of referable diabetic retinopathy is elevated in those who were not screened promptly after diagnosis of Type 2 diabetes. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 09/2013; 31(4). DOI:10.1111/dme.12313 · 3.06 Impact Factor
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    ABSTRACT: Title: The influence risk communication tools on diabetes self management Authors: Al-Athamneh N, Sturt J, Stratton IM, Lindenmeyer A, Scanlon PH. Aims 1. To explore the effect of different ways of communicating risk information about DR to people with diabetes 2. To explore the possible use of risk communication tools to improve diabetes self management. Methods A qualitative study was conducted using semi-structured interviews with a convenience sample of 25 participants. Of these, 20 participants were diagnosed with type 2 diabetes (11 White British and 9 South Asians), and 5 participants who were health care professionals (HCPs): (3 White British and 2 South Asians). HCPs were 2 GPs, an ophthalmologist, and 2 retinal screeners. Participants were purposively recruited from primary and secondary care trusts to fall into 5 groups of 5 participants each. 1) No DR (R0) 2): background DR (R1); 3) preproliferative DR (R2); 4) proliferative DR (R3); 5) HCPs. Risk communication tools were identified from different clinical settings e.g cancer screening, modified and presented to the participants. Results Providing individualised risk information in a clear and attractive style improved patients’ understanding of their own risk and therefore may also improve diabetes self management. The use of visual aids was found to facilitate the presentation of risk for those who could not read, or whose their first language was not English. Participants were able to score themselves as high or low risk, a feature which was welcomed by patients, as they liked the idea of assessing their own risk. Conclusion Visual tools may be useful in communicating the risk of DR to people with diabetes. Continuing work will now modify, evaluate, and improve a risk tool to communicate risk information about DR to people with diabetes.
    EASDec 2013, Barcelona, Spain; 05/2013
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    ABSTRACT: Purpose: The Gloucestershire Diabetic Eye Screening Programme offers annual digital photographic screening for diabetic retinopathy to a countywide population of people with diabetes. This study was designed to investigate progression of diabetic retinopathy in this programme of the English NHS Diabetic Eye Screening Programme. Methods: Mydriatic digital retinal photographs of people with diabetes screened on at least 2 occasions between 2005 and 2010 were graded and included in this study if the classification at first screening was no DR (R0), background DR in one (R1a) or both eyes (R1b). Times to detection of referable diabetic retinopathy (RDR) comprising maculopathy (M1), preproliferative (R2) or proliferative retinopathy (R3) were analysed using survival models. Results: Data were available on 19 044 patients, 56% men, age at screening 66 (57-74) years (median, 25th, 75th centile). A total of 8.3% of those with R1a and 28.2% of those with R1b progressed to any RDR, hazard ratios 2.9 [2.5-3.3] and 11.3 [10.0-12.8]. Similarly 7.1% and 0.11% of those with R1a progressed to M1 and R3, hazard ratios 2.7 [2.3-3.2] and 1.6 [0.5-5.0], compared to 21.8% and 1.07% of those with R1b, hazard ratio 9.1 [7.8-10.4] and 15.0 [7.1-31.5]. Conclusions: The risk of progression is significantly higher for those with background DR in both eyes than those with background retinopathy in only one or in neither eye.
    Acta ophthalmologica 04/2013; 91(5). DOI:10.1111/aos.12074 · 2.51 Impact Factor
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    Eye (London, England) 01/2013; DOI:10.1038/eye.2012.287 · 1.90 Impact Factor
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    Diabetic Medicine 01/2013; · 3.06 Impact Factor
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    ABSTRACT: PurposeThe purpose of this study is to define which visual acuity (VA) measurements are the best indicators of high-quality care for patients receiving intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD).Methods Analysis of prospectively collected data recorded within an electronic medical record system on treatment-naive, first-eligible eyes with nAMD, treated with ranibizumab using an as-needed treatment regimen with a minimum follow-up of 1 year. Data collection included the following: age, gender, laterality, type of nAMD, VA, central 1 mm OCT retinal thickness, number of intravitreal injections, and number of follow-up assessments.ResultsData were available on the first-treated eye from 406 patients with at least 1 year follow-up; of these, 198 had data at 2 years. The mean baseline VA of 54.4 Early Treatment Diabetic Retinopathy Study letters improved to 58.5 letters at 12 months and to 56.8 letters at 24 months. The mean VA changes from baseline to 1 year were +6.5, +7.5, +1.7, and -1.5 letters, respectively, for baseline VA categories of 23-35, 36-55, 56-70, and >70 letters. Change in mean VA from the end of the loading phase to year 1 ranged from -2.9 to +1.4 letters for the different baseline VA categories. The mean number of injections were similar across baseline VA categories ranging from 5.7 to 6.0 injections in year 1 and from 3.3 to 3.8 in year 2.Conclusions This large, real-world series demonstrates that mean change in VA is largely a function of selection criteria and baseline VA. The quality of a service is therefore better judged by actual VA outcomes and maintenance of vision after the loading phase.Eye advance online publication, 23 November 2012; doi:10.1038/eye.2012.225.
    Eye (London, England) 11/2012; 27(1). DOI:10.1038/eye.2012.225 · 1.90 Impact Factor
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    ABSTRACT: OBJECTIVE The American Diabetes Association and the English NHS Diabetic Eye Screening Program recommend annual screening for diabetic retinopathy (DR) with referral to ophthalmology clinics of patients with sight-threatening DR (STDR). Using only longitudinal data from retinal photographs in the population-based NHS Diabetic Eye Screening Program in Gloucestershire, we developed a simple means to estimate risk of STDR.RESEARCH DESIGN AND METHODS From 2005, 14,554 patients with no DR or mild nonproliferative DR only at two consecutive annual digital photographic screenings were categorized by the presence of DR in neither, one, or both eyes at each screening and were followed for a further median 2.8 years.RESULTSOf 7,246 with no DR at either screening, 120 progressed to STDR, equivalent to an annual rate of 0.7%. Of 1,778 with no DR in either eye at first screening and in one eye at second screening, 80 progressed to STDR, equivalent to an annual rate of 1.9% and to a hazard ratio (HR) of 2.9 (95% CI 2.2-3.8) compared with those with no DR. Of 1,159 with background DR in both eyes at both screenings, 299 progressed to STDR equivalent to an annual rate of 11% and an HR of 18.2 (14.7-22.5) compared with individuals with no DR.CONCLUSIONS Combining the results from 2 consecutive years of photographic screening enables estimation of the risk of future development of STDR. In countries with systematic screening programs, these results could inform decisions about screening frequency.
    Diabetes care 11/2012; 36(3). DOI:10.2337/dc12-0625 · 8.57 Impact Factor
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    ABSTRACT: Background More than 3 million people with diabetes in the UK are at risk of vision loss because of diabetic eye disease. Present UK recommendations specify annual diabetic eye screening in those aged 12 years or older with diabetes. Patients identified with potentially sight-threatening diabetic retinopathy are referred to ophthalmology services. Those with no retinopathy and those with non-referable retinal microvascular damage continue to be invited for annual screening irrespective of risk. Models for risk stratification require clinical information, including a measure of glycaemic control that may not be available to screening programmes. With use of data only from retinal photographs we aimed to identify patients at low, intermediate, and high risk of those offered annual appointments, to inform discussion about potential changes to recommended screening intervals.Methods We reviewed all patients referred from primary care to one local screening programme with assessable images of both eyes from at least three screening episodes between Jan 1, 2005, and Dec 31, 2010. Digital images were captured after dilation and were graded by a central quality assured team with NHS diabetic eye screening programme protocols. We included patients who at the first and second (index) screenings had no retinopathy or microaneuryms in one or both eyes. They were followed up until any sight-threatening diabetic retinopathy was detected or until the last available photograph with no sight-threatening diabetic retinopathy. Patients were categorised by presence of microaneuryms in neither, one, or both eyes at each screening. We excluded those with any missing data. By design, no confounding variables were included in the model. We derived life table survival plots with Kaplan-Meier estimates and calculated hazard ratios (HRs) with Cox proportional hazards models. We used log logistic models to estimate the proportion of patients with microaneuryms every year after baseline. Data were analysed with SAS (version 9.1).FindingsFrom 2005, 18–254 patients with non-referable diabetic retinopathy at two consecutive screenings were available, of whom 3700 had no further assessable images. Hence 14–554 patients were followed up for further median 2·8 years (IQR 1·3–3·3). Their median age was 65 years (IQR 56–73), and 8188 (55%) were men. Of 7246 with no evidence of retinal microvascular damage at both screenings, 120 progressed to sight-threatening diabetic retinopathy, 0·7% by 1 year. Of 1778 with microaneuryms in neither eye at first screening and in one eye at second screening, 80 progressed to sight-threatening diabetic retinopathy, 1·9% by 1 year (HR 2·9, 95% CI 2·2–3·8). Of 1159 with microaneuryms in both eyes at both screenings, 299 progressed to sight-threatening diabetic retinopathy, 11% by 1 year (HR 18·2, 95% CI 14·7–22·5). Those in higher risk groups were more likely to progress to more serious diabetic retinopathy than were those in lower risk groups.InterpretationThis screening programme of a mainly northern European population has robust quality controlled imaging and grading. Hence it needs to be validated in other populations and programmes to be generalisable. Two sequential image sets can differentiate levels of risk and could modify the interval for screening. The addition of these data to clinical indices could improve risk stratification compared with either method alone.FundingNone
    The Lancet 11/2012; 380:S69. DOI:10.1016/S0140-6736(13)60425-0 · 39.21 Impact Factor
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    ABSTRACT: The aim was to review a pathway of care for diabetic patients found to have retinal artery emboli detected by retinal screening. This was a retrospective review of a pathway agreed in 2001 by a multidisciplinary team. The prospectively collected Gloucestershire Diabetic Retinal Screening Programme database was reviewed; patients sent for carotid duplex imaging underwent review of their scan results and their casenotes. The prevalence of retinal emboli was 214 out of 25,299 diabetic patients who had retinal screening (0.85%). Some 200 diabetic patients underwent carotid duplex imaging; 23 had ipsilateral and 2 had contralateral carotid stenosis > 70%. Of these, ten patients underwent carotid endarterectomy without any major morbidity. CONCULSIONS: A pathway was established for the small number of patients with retinal emboli, and could be tested in other populations.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 05/2011; 42(2):153-7. DOI:10.1016/j.ejvs.2011.04.031 · 3.07 Impact Factor
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    ABSTRACT: To compare agreement level and identify reasons for disagreement between grading of mydriatic digital photographs in a diabetic retinopathy screening service and hospital eye service biomicroscopy grading. Structured examination findings leading to automatically calculated National Screening Committee grades recorded on an electronic medical record system in the hospital eye service at the first clinic visit after diabetic retinopathy screening service referral between April 2006 and November 2007 were retrospectively compared with the grade at the screening visit that prompted referral. In cases of disagreement, screening images were reviewed. Data on 452 eyes (226 patients) were analysed. For retinopathy, hospital eye service slit-lamp biomicroscopy grades were: R0 (no diabetic retinopathy) in 63 eyes; R1 (background retinopathy) in 251 eyes; R2 (pre-proliferative) in 129 eyes and R3 (proliferative) in nine eyes. Diabetic retinopathy screening service grades were in agreement in 350 eyes (77.4%), showed a lower grade in 59 eyes and a higher grade in 43. Agreement was moderate (κ=0.60). The most common reason for disagreement was overgrading of R1 by clinicians. Hospital eye service biomicroscopy maculopathy grades were: M0 (no maculopathy) in 366 eyes and M1 (maculopathy) in 86 eyes. Diabetic retinopathy screening service grades were in agreement in 327 eyes (72.3%), showed a lower grading in five eyes and a higher grade in 120 eyes. Agreement was moderate (κ=0.41). The commonest cause for disagreement was clinicians failing to identify fine macular exudates. This study of routine clinical services demonstrates moderate agreement between non-medical grading of mydriatic digital retinal photography images and hospital slit-lamp biomicroscopy grading of patients referred with diabetic retinopathy. The majority of errors in grading were attributable to errors by hospital doctors, usually in the direction of under-grading which could be a potential source of clinical risk if treatment is delayed.
    Diabetic Medicine 02/2011; 28(6):741-6. DOI:10.1111/j.1464-5491.2011.03273.x · 3.06 Impact Factor

Publication Stats

375 Citations
129.26 Total Impact Points

Institutions

  • 2013–2014
    • Gloucestershire Hospitals NHS Foundation Trust
      Gloucester, England, United Kingdom
  • 2010
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom
  • 2005–2010
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom