Post on 04-Jan-2016
Dorset Diabetic Eye Screening Programme2010 Update
Dr Wendy Gatling
Clinical Director DDESP
DDESP 2010 Update
• Annual Statistics
• Ungradeable & pupil dilatation
• Current Referral Pathway
• Web based Grading Exercise
• SLB & SLEs
DDESP Structure March 2010
• 45 optical practices (29 offer SLB)
• Swanage + DCH hospital clinics
• RBH + PHT monitoring clinics
• Grading: 44 optometrists (4 on leave+1 suspended+3 due to stop end March) + 4 hospital graders
• Capture only:12 screeners (1suspended)
DDESP 7.9.09 Snapshot
Sept 09 Dec 09Programme size 28,504 (33,505)Eligible for screening 25,468 (29,957)Excluded 425 (1.5%)Opted out 133 (0.5%)Community SLB 1198Hospital SLB 196Ophthalmology 2,065 (7.2%)April 2010 EQA review standard >2% excluded
considered unsafe
Annual Report 2008/9
• Digital screening 22,599 patients [26,006 tests] • SLB examinations 1,496 by optometrists• Attended screening ~ 89%Optical Practice Activity (from Orion payments)
Capture 21,838
Grading 20,252
Concurrent SLB 1,273 **
Separate SLB 223
Grading Results
• Proliferative R3 237 patients
• Pre-proliferative R2 183 patients
• Maculopathy M1 840 patients
• Required SLB 528 patients
• Referred to ophthalmology 293 patients in 6 months [projected 586 for 1 year]
Prevalence of any retinopathy
Annual Report 08/09
All images graded 23,494
Any retinopathy detected 7,283 (31%)
Prevalence of Any Retinopathy in Digital Imaging in DDESP
0
5
10
15
20
25
30
35
40
01/10/2005-31/03/2006
01/10/2006-31/03/2007
01/04/2007-30/09/2007
01/10/2007-31/03/2008
01/04/2008-30/09/2008
01/10/2008-31/03/2009
01/04/2009-31/08/2009
Half Year Period
Per
Cen
t
Any retinopathy%*
Prevalence of any retinopathy April-Dec 09 33%
Ungradeable Rate
Orion report 2008/9213 unassessable1070 unobtainableTotal 4.4%
Orion report April-Dec 09325 unassesable941 unobtainableTotal 6.5%
How to Use Orion for SLB grading
Reducing Ungradeable Images
New pupil dilation protocol
1% tropicamide 1 drop each eye
Repeat after 15 minutes
Inadequate dilation at 30 minutes
2.5% phenylephrine [STOCK ITEM]
Patient notes – use 2 mydriatics
DDESP Referral Pathway
• All patients with any retinopathy or unassessable go to second disease grade
• All R2, R3 or M1 potentially referable to MDT
• New protocols for R3.2 or R3.3
• New protocol for M1 with reduced VA and dots or haemorrhages only
DDESP weekly MDTs
January to June 09 About 33 patients per week
Total patients reviewed 855
Referred to Hospital Eye Service (HES)
269
% referred to HES 31%
Returned to screening 588
% returned to screening 69%
Patients Treated for DR
Screening to treatment time audit
Oct 08-March 09 67 patients
All patients treated by laser
April 08 to March 09 RBH & PHT 198
Oct 08 to March 09 RBH, PHT & DCH 238NB Estimate 23% of patients receiving laser come
after first HES from DDESP
Web based Grading Exerciseending Dec 2009
• 42 of 43 eligible graders and 1 capture technician participated
• Good results overall
• 20 graders suggested grading session – individual and group sessions
NEXT EXERCISE OPEN
• 50 imagesets by end of May 2010
DDESP & EQA grading testsnew targets
Test type Minimum score No of tests per 6-month period
Dorset web test (50 questions per test set)
80% sensitivity for sight threatening retinopathy
1
National DRSEQA test set (30 questions per test set)
80% overall score 2
Score Result target
Interpretation of achieving target
Sensitivity for STR > 90% Low under grading Missing less than 1 in 10 patients with STR
Sensitivity for any retinopathy
> 95% Low under gradingMissing less than 1 in 20 patients with any retinopathy
Specificity for STR 95% Low over gradingCorrectly grading 19 of 20 patients as not having STR
Specificity for any retinopathy
75% Low over gradingCorrectly grading 15 of 20 patients as having no retinopathy
National EQA test sets
DDESP53 graders 31% logged on
New feature
Welcome to the online EQA system
View history
Welcome to the On-Line EQA System
View History »HideHistory »Your History
Print History »
Level No. times Presentedas correct
No. timesanswered correctly
% timesanswered correctly
No. timesOvergraded
% of timesOvergraded
No. of timesUndergraded
% of timesUndergraded
R 30 20 67 % 1 3 % 9 30 %
R0 0 0 0 % 0R1 - 0R2 - 0R3 - 0
0 % 0 0
R1 17 12 71 % 1 R2 - 0R3 - 1 6 % 4 R0 - 4 24 %
R2 5 2 40 % 0 R3 - 0 0 % 3 R0 - 0R1 - 3 60 %
R3 8 6 75 % 0 0 2R0 - 0R1 - 1R2 - 1
25 %
M 30 27 90 % 2 7 % 1 3 %
M0 22 20 91 % 2 M1 - 2 9 % 0 0
M1 8 7 88 % 0 0 1 M0 - 1 12 %
Period September
EQA Grade
R0 R1M0 R1M1 R2M0 R2M1 R3M0 R3M1
R0 0 0 0 0 0 0 0
R1M0 3 9 1 0 0 1 0
R1M1 1 0 2 0 0 0 0
R2M0 0 1 0 2 0 0 0
R2M1 0 0 2 0 0 0 0
R3M0 0 1 0 0 0 3 1
R3M1 0 0 0 0 1 0 2
SLB & SLEs in DDESP
Barriers to Implementation: target April 2011
Pilot group of 7 optometrists to ‘train’ & become accredited SLE at PHT JRC
Second group of 3-5 optometrists in Autumn 2010