Screening for Diabetic Retinopathy in Europe Progress since 2005 Report from National Representatives Meeting Simon Harding Amsterdam 30th May 2008

The St. Vincent Declaration Implement effective measures for the prevention of costly complications Reduce new blindness due to diabetes by one third or more General Goal for people with diabetes Sustained improvement in health experience and life approaching normal expectation in quality and quantity

Liverpool 2005 Liverpool Town Hall 17-18th November 2005

The Liverpool Declaration European countries should: Reduce the risk of visual impairment due to diabetic retinopathy by 2010 through: systematic programmes of screening reaching at least 80% of the population with diabetes using trained professionals and personnel universal access to laser therapy

Three components Organisation Personnel Equipment, tests and treatment

Implementation Establish joint meetingsEstablish joint meetings Set up training programmesSet up training programmes Move from local to regional to national implementationMove from local to regional to national implementation Establish policy including defined goalsEstablish policy including defined goals Set national guidelinesSet national guidelines Agree timeframeAgree timeframe Don’t give up!Don’t give up! 30 May 2008Amsterdam

Conference objectives To review Liverpool Declaration targets and report on progress To describe obstacles to implementation To develop further guidance To engage stakeholders

Delegates 46 European countries invited diabetologist, ophthalmologist 26 European countries represented 67 delegates

Groups of Nations Group 1 Czech Republic, Hungary, Poland, Serbia, Turkey Group 2 Denmark, England, Finland, Iceland, Scotland, Sweden, Wales Group 3 Belgium, France, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, (Germany, Israel, Spain) Group 4 Albania, Belarus, Bulgaria, Georgia, Lithuania 30 May 2008Amsterdam

Key messages Significant progress made since 2005 Nearly all countries have taken a step forward: established systematic screeningestablished systematic screening developing local to regional to nationaldeveloping local to regional to national patchy progress:patchy progress: –development of national guidelines –training programmes being started –regional/national implementation groups This has been led by a small/medium groups of champions in each country 30 May 2008Amsterdam ~1/3 report likely to achieve 2010 targets, others part

Key messages Wide variation in prevalence 3-5% majority3-5% majority 7.9% Belgium, 6.9% Portugal, 7% Georgia7.9% Belgium, 6.9% Portugal, 7% Georgia 9.0% Finland high frequency of type 19.0% Finland high frequency of type 1 >10% Greece>10% Greece PDR 23.5% in Czech RepublicPDR 23.5% in Czech Republic <2% in Belarus, Bulgaria, Lithuania; <1% in Albania<2% in Belarus, Bulgaria, Lithuania; <1% in Albania Expected big increase 30 May 2008Amsterdam

Key messages Access to laser still poor in a few countries Problems with continued secure funding in long established programmes (Iceland) Some bizzare perverse incentives avastin/TA being given even when laser is availableavastin/TA being given even when laser is available 30 May 2008Amsterdam

Issues identified Public awareness Patient compliance Lack of funding for equipment, training, education Collaboration between ophthalmologists and diabetologists Lack of engagement of private providers of eye care systematic process, competency, registers, data Political instability 30 May 2008Amsterdam

Recommendations Group 1 Raise awareness of diabetes and retinopathy particularly primary care providers also patients and public Adequate funding for lasers and fundus cameras (personnel not such an issue) Establish call recall systems as the key method of the development of diabetes registers can only be achieved by moving from local to regional to national

Recommendations Group 2 For established screening programmes: Quality improvement plan against explicit measureable standards across all components of screening and management focus on management of screen positive cases Comprehensive list of people with diabetes with regular maintenance Integrate eye screening results with general diabetes care

Recommendations Group 3 Develop registers of people with diabetes consider alternative sources of data: pharmacy, pharmaceutical data, insurance data unique identifiers local – regional – national Engage private eye care providers involve health insurers in establishing systematic screening guidelines for all professional groups should require fundus imaging at the agreed frequency data transmission to a linked independently funded database ensure no requirement to refer screen +ve patients

Recommendations Group 4 Raise awareness of diabetes and retinopathy particularly with patient groups Adequate funding for lasers and fundus cameras particularly for training programmes Governments should fund the development and adoption of guidelines funding can be better utilised if the frequency of screening can be reduced Mobile screening is most relevant to rural areas

How can we make further progress? European Organisations Representatives: Dr. Christoph Steffen, European Commission, Information Society & Media DG Dr. Wim Wientjens, Vice President, International Diabetes Foundation Dr. Ivo Kocur, Prevention of Blindness and Deafness (PBD), World Health Organisation Dr. Karl-Jurgen Schmitt, Chairman, Structural Funds Task Force, COCIR

Where next? draft conference report circulated to national representatives final report circulated to key European organisations website will post abstracts and presentations next meeting in 2011 to review 2010 targets

Organising Committee Deborah Broadbent, Simon Harding, Ken Swa, Bettine Polak, Annette Moll Moderators Deborah Broadbent, Eva Kohner, Ken Swa, Simon Harding Conference Secretariat Lindy Gee, Jitta Reddingius, Ingrid van Vegde

Thank you