Wendy Newsom Lead Optometrist Cambridgeshire DRSS CVi Audit Patel Gordon-Bennett (MRCOphth) Declan Flanagan (FRCOphth)

Audit objectives To obtain the rates of visual impairment registration due to Diabetic Retinopathy in the population covered by CambsDRSS To compare this rate to previous audit (2004) To compare with National Standards

Service Objectives and Quality Assurance Standards: Release 6.5, June 2009 Standard 1- Objective To reduce new blindness due to diabetic retinopathy –National rates in 1990/91 = SSi 9.5 per million per annum Si 9.3 per million per annum –SSi VA of 6/60 or worse in the better eye –Si VA of 6/18 or worse in the better eye

Standards Minimum –10% reduction within 5 years of start of screening programme Achievable –40% reduction within 5 years of start of screening programme. Bunce C, Wormald R. Leading causes of certification for blindness and partial sight in England & Wales. BMC Public Health Mar 8; 6:58. SSi 13.6 per million per year in 1999/2000 Si 24.8 per million per year in 1999/2000

Methods Retrospective review of CVi forms registered in 2007 at Cambs County Council and Peterborough County Council Validation by review of CVi forms at Addenbrooke’s, Hinchingbrooke and Peterborough Hospitals Data collection of patients with South Cambs, Cambridge city, Hunts, and Peterborough post codes (East Cambs and Fenland excluded) –Type of Registration –Age at Registration –Primary Cause of visual loss for registration –Post Code (1 st half) + GP Post Code Population of Cambs and Peterborough obtained from Census 2001

Demographics Population of Cambridgeshire (excluding East Cambs and Fenland) 555,916 -CambsDRSS population –Hunts 156,950, –Cambridge City 108,879 –South Cambs 130,087 –Peterborough 160,000

Results 315 CVi forms in 12 months 139 (44%) SSi 170 (54%) Si 6 data not recorded on CVi 21 predominantly due to DR –7 SSi –14 Si

Comparison with standard () Cambs CVi registrations (2007) –SSi 12.6 per million per year (9.3) (13.6) –Si 25.2 per million per year (9.2) (24.8) –Previous Cambridgshire audit 2004 SSi 14.4 per million per year Si 21.3 per million per year Cambridgshire including Fenland excluding Peterborough

Local Numbers Numbers of CVi for DR 2008 SSi 11 (7) Si 19 (14) Hinchingbrooke Hospital Huntingdon – SSi 4 SSi 2 Si 5 Addenbrookes Hospital Cambridge – SSi 1 SSi 4 Si 3 Si 5 Peterborough District Hospital – SSi 2 SSi 5 Si 6 Si 9

Recommendations A good CVi audit is a large undertaking A 5 year gap between audits would appear to be a good interval (numbers are v. small) CVi Database should be held at the eye dept Record postcode of both patient and GP to ensure correct boundaries for the DRS Scheme Might be able to use the national CVi database, held at Moorfields, for verifcation of local/national figures