The DR SPOC study: Diabetic retinopathy screening in an outreach model

Lakni Weerasinghe1, Hamish Dunn1,2,3, Wah Cheung2,3, Glen Maberly2,4,5, Christian Girgis 2,3, Gerald Liew2,3, Helen Do2,3, Tien‐Ming Hng4,5, Rajini Jayaballa4,5, Alison Pryke3, Belinda Ford1,3,6, Seema Gurung3, Sian Bramwell4, Manyu Shi3, Ramy Bishay4,5, Sumathy Ravi4, Gideon Meyerowitz‐Katz4, Lisa Keay7,6, Andrew White2

Meeting:  2019 RANZCO


Date:      -

Session Title: Epidemiology/Public Health

Session Time:      -

Purpose: Diabetic retinopathy (DR) is the leading cause of blindness and visual disability in working‐age adults and affects 1‐in‐3 people with diabetes mellitus (DM). While timely diagnosis and intervention can prevent vision‐loss in up to 90% of at‐risk patients, national screening uptake is low. This study aims to determine the diagnostic utility of an easily‐accessible outreach DR screening model at tertiary point‐of‐care settings for high‐risk populations.

Method: Cross‐sectional, opportunistic, instrument‐validation study on diabetic patients attending integrated‐care or foot‐ulcer clinics at Blacktown or Westmead Hospitals, between February‐August 2019. DR‐status was assessed using two‐field non‐mydriatic fundus photography and electroretinogram/pupillometry (ERG) [RetinaVue 100 & RETeval, Welch Allyn], with mydriatic photographs used as the reference standard. Results were graded by an ophthalmologist.

Results: Recruitment, as of June 2019, was 188 patients, 129 of whom had been assessed. Photographs on average took only 4.6 minutes, while ERG took 3.7 minutes. Overall, 48 (37.2%) were diagnosed with any DR, while 18 (14%) had vision‐threatening DR (VTDR); 31 (64.6%) and 14 (77.8%) of which were previously undiagnosed, respectively. This prevalence is significantly greater than community rates of DR (28.5%) and VTDR (4.5%), as reported by the 2014‐2015 National Eye Health Survey.

Conclusion: Outreach DR‐screening at tertiary point‐of‐care settings demonstrates a model of care which is easily‐accessible and successfully detects high levels of undiagnosed DR, highlighting the value of targeted screening for high‐risk diabetic populations.