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66,000 adults & children in NI with diabetes
Estimates of ca 12,500 people who are as yet
unaware that they have the condition
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Damage to small blood vessels
Vessels may become blocked or leaky
New vessels may grow, and these may bleed
easily
Major cause of blindness in working
population
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Condition should be an important health
problem
Should be treatable
Facilities for diagnosis and Tx should be
available
Test should be acceptable to population
Natural history of the disease should be
understood
Should be an agreed policy on who to treat
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Case finding should be continuous
Total cost of finding a disease should be
balanced in relation to medical expenditure
as a whole
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“Screening is the process of identifying those
individuals at a signifigantly high risk of a
specific disorder to warrant further
investigation or direct action”
...”is normally asymptomatic , usually
medically initiated and not requested by the
patient...”
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Sensitivity: proportion of people WITH the
disorder who test positive on a screening test
Specificity: proportion of people who do NOT
have the disorder who test negative...
Northern Ireland
Context
Priorities for Action
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By 2007, Boards & Trusts expected to have in
place a programme of diabetic retinopathy
screening to cover the whole of Northern
Ireland
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To reduce visual morbidity caused by diabetic
retinopathy by facilitating early diagnosis &
treatment of sight-threatening retinopathy
through population screening...
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Annual retinal screening should be offered to
all eligible individuals with diabetes
Screening should be carried out by digital
retinal photography
Those identified as having potentially sightthreatening should have rapid access to
specialist assessment & treatment
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Screening is a programme to reduce the risk
of disease
It is not a guarantee of diagnosis or cure
It includes:
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Identification of the population to be
screened
Public & professional awareness
Written information
Training of health professionals
Offer & application of screening test
Appropriate follow-up of positive screens
Feedback
Standards & QA
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Most patients with
diabetes are eligible for
screening, apart from...
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<12 years old
Informed choice to opt
out
NPL in either eye
Are registered blind or
PS due to diabetes
Are terminally ill or to
infirm to participate
Physical or mental
disability
Currently under the care
of ophthalmologist for
DR
CAPTURE OF DIGITAL IMAGES
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Although the model of
delivery varies by
geographical location, all
operate to agreed Regional
QA Standards & are
subject to performance
monitoring
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There is a regional Call/Recall system for
primary care practices for the screening
programme. DRSS initiates contact & offers
GP practices screening visits on a rolling
cycle. Within this cycle, screening is offered
according to clinical risk criteria.
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Two or more photographs are taken of the
back of the eye
Images are assigned & digitally stored
Transferred to DRSS offices for
interpretation, analysis & information
sharing.
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Images & details are stored for at least 8
years
This is useful to track changes over time &
also to monitor the quality of the screening
programme.
If DR is detected, referral to eye clinic for
further assessment is indicated.
Otherwise, screening is invited again in 12/12
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Demographics
Epidemiology
Resources
Maintenance of competencies
Thank You
Information sharing...