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Incidence of sight-threatening diabetic retinopathy in an established urban screening programme: an 11-year cohort study

Incidence of sight-threatening diabetic retinopathy in an established urban screening programme: an 11-year cohort study
Incidence of sight-threatening diabetic retinopathy in an established urban screening programme: an 11-year cohort study

Aims: systematic annual screening to detect sight-threatening diabetic retinopathy (STDR) is established in the United Kingdom. We designed an observational cohort study to provide up-to-date data for policy makers and clinical researchers on incidence of key screening endpoints in people with diabetes attending one screening programme running for over 30 years.

Methods: all people with diabetes aged ≥12 years registered with general practices in the Liverpool health district were offered inclusion. Data sources comprised: primary care (demographics, systemic risk factors), Liverpool Diabetes Eye Screening Programme (retinopathy grading), Hospital Eye Services (slit lamp biomicroscopy assessment of screen positives).

Results: 133,366 screening episodes occurred in 28,384 people over 11 years. Overall incidences were: screen positive 6.7% (95% CI 6.5–6.8), screen positive for retinopathy 3.1% (3.0–3.1), unassessable images 2.6% (2.5–2.7), other significant eye diseases 1.0% (1.0–1.1). 1.6% (1.6–1.7) had sight-threatening retinopathy confirmed by slit lamp biomicroscopy. The annual incidence of screen positive and screen positive for retinopathy showed consistent declines from 8.8%–10.6% and 4.4%–4.6% in 2007/09 to 4.4%–6.8% and 2.3%–2.9% in 2013/17, respectively. Rates of STDR (true positive) were consistently below 2% after 2008/09. Screen positive rates were higher in first time attenders (9.9% [9.4–10.2] vs. 6.1% [6.0–6.2]) in part due to ungradeable images (4.1% vs. 2.3%) and other eye disease (2.4% vs. 0.8%). 4.5% (3.9–5.2) of previous non-attenders had sight-threatening retinopathy. Compared with people with type 2 diabetes, those with type 1 disease demonstrated higher rates of screen positive (11.9% vs. 6.0%) and STDR (6.4% vs. 1.2%). Overall prevalence of any retinopathy was 27.2% (27.0–27.4).

Conclusions: in an established screening programme with a stable population screen, positive rates show a consistent fall over time to a low level. Of those who are screen positive, fewer than 50% are screen positive for diabetic retinopathy. Most are due to sight threatening maculopathy. The annual incidence of STDR is under 2% suggesting future work on redefining screen positive and supporting extended intervals for people at low risk. Higher rates of screen positive and STDR are seen in first time attenders. Those who have never attended for screening should be specifically targeted.

incidence, prevalence, screen positive, screening, sight-threatening diabetic retinopathy
0742-3071
Cheyne, Christopher P.
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Burgess, Philip I.
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Broadbent, Deborah M.
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García-Fiñana, Marta
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Stratton, Irene M.
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Criddle, Ticiana
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Wang, Amu
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Alshukri, Ayesh
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Rahni, Mehrdad M.
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Vazquez-Arango, Pilar
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Vora, Jiten P.
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Harding, Simon P.
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Lees, Peter
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Jones, Lisa
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ISDR Study Group
Cheyne, Christopher P.
ec078d25-27f4-4e9f-a8ed-0066d33a492c
Burgess, Philip I.
a050e85b-e6c0-41db-815e-19e29a6ead2b
Broadbent, Deborah M.
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García-Fiñana, Marta
3ed2efab-455f-42bf-ae3e-4171a6af98ed
Stratton, Irene M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Criddle, Ticiana
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Wang, Amu
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Alshukri, Ayesh
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Rahni, Mehrdad M.
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Vazquez-Arango, Pilar
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Vora, Jiten P.
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Harding, Simon P.
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Lees, Peter
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Jones, Lisa
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Cheyne, Christopher P., Burgess, Philip I., Broadbent, Deborah M., García-Fiñana, Marta, Stratton, Irene M., Criddle, Ticiana, Wang, Amu, Alshukri, Ayesh, Rahni, Mehrdad M., Vazquez-Arango, Pilar, Vora, Jiten P. and Harding, Simon P. , ISDR Study Group (2021) Incidence of sight-threatening diabetic retinopathy in an established urban screening programme: an 11-year cohort study. Diabetic Medicine, 38 (9), [e14583]. (doi:10.1111/dme.14583).

Record type: Article

Abstract

Aims: systematic annual screening to detect sight-threatening diabetic retinopathy (STDR) is established in the United Kingdom. We designed an observational cohort study to provide up-to-date data for policy makers and clinical researchers on incidence of key screening endpoints in people with diabetes attending one screening programme running for over 30 years.

Methods: all people with diabetes aged ≥12 years registered with general practices in the Liverpool health district were offered inclusion. Data sources comprised: primary care (demographics, systemic risk factors), Liverpool Diabetes Eye Screening Programme (retinopathy grading), Hospital Eye Services (slit lamp biomicroscopy assessment of screen positives).

Results: 133,366 screening episodes occurred in 28,384 people over 11 years. Overall incidences were: screen positive 6.7% (95% CI 6.5–6.8), screen positive for retinopathy 3.1% (3.0–3.1), unassessable images 2.6% (2.5–2.7), other significant eye diseases 1.0% (1.0–1.1). 1.6% (1.6–1.7) had sight-threatening retinopathy confirmed by slit lamp biomicroscopy. The annual incidence of screen positive and screen positive for retinopathy showed consistent declines from 8.8%–10.6% and 4.4%–4.6% in 2007/09 to 4.4%–6.8% and 2.3%–2.9% in 2013/17, respectively. Rates of STDR (true positive) were consistently below 2% after 2008/09. Screen positive rates were higher in first time attenders (9.9% [9.4–10.2] vs. 6.1% [6.0–6.2]) in part due to ungradeable images (4.1% vs. 2.3%) and other eye disease (2.4% vs. 0.8%). 4.5% (3.9–5.2) of previous non-attenders had sight-threatening retinopathy. Compared with people with type 2 diabetes, those with type 1 disease demonstrated higher rates of screen positive (11.9% vs. 6.0%) and STDR (6.4% vs. 1.2%). Overall prevalence of any retinopathy was 27.2% (27.0–27.4).

Conclusions: in an established screening programme with a stable population screen, positive rates show a consistent fall over time to a low level. Of those who are screen positive, fewer than 50% are screen positive for diabetic retinopathy. Most are due to sight threatening maculopathy. The annual incidence of STDR is under 2% suggesting future work on redefining screen positive and supporting extended intervals for people at low risk. Higher rates of screen positive and STDR are seen in first time attenders. Those who have never attended for screening should be specifically targeted.

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Accepted/In Press date: 22 March 2021
e-pub ahead of print date: 8 April 2021
Published date: 9 June 2021
Additional Information: Funding Information: this study was funded by the UK National Institute for Health Research (NIHR) (Programme Grants for Applied Research [RP‐PG‐1210‐12016]). The views expressed are those of the authors, not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all data in the study and has final responsibility for the decision to submit. Funding Information: this study was funded by the UK National Institute for Health Research (NIHR) (Programme Grants for Applied Research [RP-PG-1210-12016]). The views expressed are those of the authors, not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all data in the study and has final responsibility for the decision to submit. The authors are grateful to the ISDR Patient and Public Involvement Group for essential input into design and review and enthusiastic support for the study, to the Liverpool Care Commissioning Group for data extraction and transfer, and to the Liverpool Local Medical Committee and local general practitioners for support with establishing patient lists and consent. ISDR Study Group Authors: Christopher P. Cheyne, Philip Burgess, Deborah M. Broadbent, Marta Garc?a-Fi?ana, Irene M. Stratton, Ticiana Criddle, Amu Wang, Ayesh Alshukri, Mehrdad M. Rahni, Pilar Vazquez-Arango, Jiten P. Vora, Simon P. Harding (Study Group Chair). Collaborators: ISDR investigators: Paula Byrne, Anthony C. Fisher, Mark Gabbay, Marilyn James, Tracy Moitt, John R. Roberts, Daniel Seddon, Paula Williamson; ISDR Research staff: Duncan Appelbe, Antonio Eleuteri, Christopher Grierson, Lola Howard, Susan U. Howlin, James G. Lathe, Andy Ovens, Christopher J. Sampson, Kate Silvera, David Szmyt, Clare Thetford, Abigail E. Williams; Patient and Public Involvement Group: John Collins, Emily Doncaster John Kelly, Peter Lees, Sandra Lees, Betty Williams; Programme and Independent Data Safety Committees: Helen Cooper, Gideon Smith, Vineeth Kumar, Chris Rogers, Alison Rowlands, Julia West, Naveed Younis, Nathalie Massat, Catey Bunce; Liverpool Diabetic Eye Screening Programme: Stephanie Perrett: Liverpool Clinical Commissioning Group: Lisa Jones.
Keywords: incidence, prevalence, screen positive, screening, sight-threatening diabetic retinopathy

Identifiers

Local EPrints ID: 487014
URI: http://eprints.soton.ac.uk/id/eprint/487014
ISSN: 0742-3071
PURE UUID: a390e537-3ccf-4bfd-867f-bd2e5382b55a
ORCID for Irene M. Stratton: ORCID iD orcid.org/0000-0003-1172-7865

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Date deposited: 09 Feb 2024 17:41
Last modified: 18 Mar 2024 04:01

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Contributors

Author: Christopher P. Cheyne
Author: Philip I. Burgess
Author: Deborah M. Broadbent
Author: Marta García-Fiñana
Author: Irene M. Stratton ORCID iD
Author: Ticiana Criddle
Author: Amu Wang
Author: Ayesh Alshukri
Author: Mehrdad M. Rahni
Author: Pilar Vazquez-Arango
Author: Jiten P. Vora
Author: Simon P. Harding
Author: Peter Lees
Author: Lisa Jones
Corporate Author: ISDR Study Group

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