Abstract
IntroductionDiabetic macular edema (DME) is an important cause of vision loss. England has a national systematic photographic retinal screening programme to identify patients with diabetic eye disease. Grading retinal photographs according to this national protocol identifies surrogate markers for DME. We audited a care pathway using a spectral-domain optical coherence tomography (SDOCT) clinic to identify macular pathology in this subset of patients.MethodsA prospective audit was performed of patients referred from screening with mild to moderate non-proliferative diabetic retinopathy (R1) and surrogate markers for diabetic macular edema (M1) attending an SDOCT clinic. The SDOCT images were graded by an ophthalmologist as SDOCT positive, borderline or negative. SDOCT positive patients were referred to the medical retina clinic. SDOCT negative and borderline patients were further reviewed in the SDOCT clinic in 6 months.ResultsFrom a registered screening population of 17 551 patients with diabetes mellitus, 311 patients met the inclusion criteria between (March 2008 and September 2009). We analyzed images from 311 patients’ SDOCT clinic episodes. There were 131 SDOCT negative and 12 borderline patients booked for revisit in the OCT clinic. Twenty-four were referred back to photographic screening for a variety of reasons. A total of 144 were referred to ophthalmology with OCT evidence of definite macular pathology requiring review by an ophthalmologist.DiscussionThis analysis shows that patients with diabetes, mild to moderate non-proliferative diabetic retinopathy (R1) and evidence of diabetic maculopathy on non-stereoscopic retinal photographs (M1) have a 42.1% chance of having no macular edema on SDOCT imaging as defined by standard OCT definitions of DME when graded by a retinal specialist. SDOCT imaging is a useful adjunct to colour fundus photography in screening for referable diabetic maculopathy in our screening population.
Highlights
Diabetic macular edema (DME) is an important cause of vision loss
A total of 144 were referred to ophthalmology with Optical Coherence Tomography (OCT) evidence of definite macular pathology requiring review by an ophthalmologist. This analysis shows that patients with diabetes, mild to moderate non-proliferative diabetic retinopathy (R1) and evidence of diabetic maculopathy on non-stereoscopic retinal photographs (M1) have a 42.1% chance of having no macular edema on spectraldomain optical coherence tomography (SDOCT) imaging as defined by standard OCT definitions of DME when graded by a retinal specialist
We report a prospective audit of patients referred from diabetic retinal screening service (DRSS) with R1/M1 maximal retinopathy in either eye attending an SDOCT clinic
Summary
Diabetic macular edema (DME) is an important cause of vision loss. England has a national systematic photographic retinal screening programme to identify patients with diabetic eye disease. Grading retinal photographs according to this national protocol identifies surrogate markers for DME. We audited a care pathway using a spectraldomain optical coherence tomography (SDOCT) clinic to identify macular pathology in this subset of patients. Diabetic macular edema (DME) is a common cause of sight-threatening retinopathy.[3] The Early Treatment Diabetic Retinopathy Study (ETDRS) identified patients with diabetic maculopathy at risk of vision loss. Macular laser was shown to prevent vision loss if applied according to protocol when the level of maculopathy reached so-called, ‘clinically significant macular edema’ (CSME). Patients with less severe levels of maculopathy, including so-called non-CSME levels of edema, did not achieve benefit from laser.[4]
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