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