The prevalence and incidence of diabetic eye disease in a screening programme
Başlık:
The prevalence and incidence of diabetic eye disease in a screening programme
Yazar:
Younis, Naveed, author.
ISBN:
9780355977882
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (250 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 76-08C.
Özet:
Diabetic retinopathy remains a major cause of preventable visual loss in developed countries. Screening for Sight Threatening Diabetic Retinopathy (STDR) has been widely recommended and is a high priority in the United Kingdom where national screening for diabetic retinopathy is being instigated. Many countries have attempted to standardize retinal screening programmes and to introduce systematic quality assurance. Large-scale baseline prevalence and incidence measurements in populations at the introduction of systematic retinal screening are generally unavailable in the UK and most other developed countries. Such data is essential for health providers for estimation of yield and quality assurance. Guidelines on screening for diabetic retinopathy have been developed in western populations. Up to now, most have recommended a yearly screen interval for patients with no diabetic retinopathy but on the basis of expert group opinion rather than direct evidence. This thesis aims to investigate the epidemiology of diabetic retinopathy in an established screening programme. The baseline prevalence, incidence and associated risk factors of grades of retinopathy and STDR were determined for patients with both Type 1 and Type 2 diabetes mellitus (DM). This thesis also aims to determine the optimal screening intervals for grades of retinopathy and the hypothesis that patients without retinopathy have a low incidence of STDR and therefore can be screened at longer intervals than annually. All patients with Type 1 and Type 2 DM registered with enrolled general practices, except those who were attending an ophthalmologist, were invited for annual retinal screening. Patients underwent non-stereoscopic three field mydriatic photography and modified Wisconsin grading. STDR was defined as moderate preproliferative retinopathy or worse or clinically significant maculopathy in either or both eyes. Screen intervals were determined for a specified degree of likelihood of progression to STDR, the primary outcome of retinal screening, stratified for baseline retinopathy status. Results were obtained from 26,550 individual screen events between the period 1991 and 2000 inclusive. For 831 patients with Type 1 DM, the prevalence of any retinopathy was 45.7% and STDR 16.4% at baseline screen. The presence of STDR was associated with disease duration (P< 0.0001) and was higher in men (P=0.001). The incidence of STDR in patients with Type 1 DM and no baseline retinopathy was 0.3% at 1 year rising to 3.9% at 5 years. Rates of progression were greater with higher grades of baseline retinopathy. The mean screen interval for a 95% probability of remaining free of STDR was 5.7 years in patients with no retinopathy in Type 1 DM. The baseline prevalence of any retinopathy was 25.3% and STDR 6.0% in 7,231 patients with Type 2 DM. Presence of STDR was associated with duration (P<0.0001) and insulin usage (P<0.0001). Incidence of STDR at one year was 0.3% rising to 1.8% in the fifth year in patients with Type 2 DM and no retinopathy. The screen interval for a 95% probability of remaining free of STDR was 5.4 years in Type 2 DM patients with no baseline retinopathy. In conclusion, the baseline prevalence of STDR is high in patients with both Type 1 and Type 2 DM at the institution of systematic retinal screening and is strongly associated with disease duration. For patients with both Type 1 and Type 2 DM, a 3-year screen interval can be safely adopted for patients with no retinopathy but yearly or more frequent screening is recommended for patients with higher grades of retinopathy. This may result in significant cost savings and greater cost effectiveness for future screening programmes.
Notlar:
School code: 1543
Konu Başlığı:
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(683824.1) | 683824-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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