Mark Cahill, Global Vision National Diabetic Retinopathy Screening Programme

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Innovation in Community based Practice

Innovation in Community based Practice

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  • 1. Diabetic Retina Screen Screening for Diabetic Retinopathy in Ireland Mark Cahill MCh, FRCSI (Ophth) Clinical Lead Global Vision
  • 2. The Eye Retina - layer like wet tissue paper that lines the inside of the eye Macula - Important central area of retina
  • 3. 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.
  • 4. Proliferative Diabetic Retinopathy
  • 5. Diabetic Macular Oedema
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. Compelling case for Diabetic Retinopathy screening Diabetic Retinopathy Role of screening • # 1 Cause of blindness in people • Annual screening examinations 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)* 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 *Does not include all the indirect socio-economic costs associated with blindness
  • 10. Diabetic Retina ScreenThe National Diabetic Retinal Screening Programme National Cancer Screening Service Dr Margaret Morgan - Clinical Lead Pat Cafferty - Programme Manager Leahna Kelly – Programme Co-ordinator Contract out Photography and Grading service to two Providers Global Vision Leinster except Meath and Westmeath Medical Imaging Rest of the country (Competitive tender awarded in December 2012)
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. Digital Photographic Screening - Colour Photos
  • 15. 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)
  • 16. Results Patient: – 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) code Certain 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)
  • 17. 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)
  • 18. Global Vision First patient screened 11th March 2013 Global Vision Team Graders & Photographers = 8 Ophthalmologists = 4 Clinical Lead Mark Cahill Programme Ophthalmologist Pat McGettrick Administration team & Service Leads = 3 Programme Director Sinead O Connor Programme Manager Adele Dunne IT Support = 1
  • 19. 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
  • 20. DRS patient information
  • 21. Acknowledgements National Cancer Screening Service Heart of England Diabetic Retinopathy Screening Centre, Birmingham Global Vision Photographers and Graders