Dorset Diabetic Eye Screening Programme 2010 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 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 Snapshot Sept 09 Dec 09 Programme size 28,504 (33,505) Eligible for screening25,468 (29,957) Excluded425 (1.5%) Opted out133 (0.5%) Community SLB1198 Hospital SLB196 Ophthalmology 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) Capture21,838 Grading20,252 Concurrent SLB 1,273 ** Separate SLB 223

Grading Results Proliferative R3237 patients Pre-proliferative R2183patients 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 April-Dec 0933%

Ungradeable Rate Orion report 2008/9 213 unassessable 1070 unobtainable Total 4.4% Orion report April-Dec unassesable 941 unobtainable Total 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 09About 33 patients per week Total patients reviewed855 Referred to Hospital Eye Service (HES) 269 % referred to HES31% Returned to screening588 % returned to screening69%

Patients Treated for DR Screening to treatment time audit Oct 08-March 0967 patients All patients treated by laser April 08 to March 09 RBH & PHT198 Oct 08 to March 09 RBH, PHT & DCH 238 NB Estimate 23% of patients receiving laser come after first HES from DDESP

Web based Grading Exercise ending Dec 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 tests new targets Test typeMinimum scoreNo 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 score2 ScoreResult 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 grading Missing less than 1 in 20 patients with any retinopathy Specificity for STR95%Low over grading Correctly grading 19 of 20 patients as not having STR Specificity for any retinopathy 75%Low over grading Correctly grading 15 of 20 patients as having no retinopathy

National EQA test sets DDESP53 graders31% 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 » Full disease grade Rationale: Image test sets derived to assess a person's ability to categorise diabetic retinopathy with respect to R Level and M Level. P Level is not required.Full disease grade Rationale: Image test sets derived to assess a person's ability to categorise diabetic retinopathy with respect to R Level and M Level. P Level is not required. Attempts Summary 1st PeriodAugust You started but did not complete this image set You scored 0 / 00 % Charts for August » 2nd Perio d Septembe r You completed this image set You scored 47 / 6078 % Charts for September » 5th PeriodDecember You completed this image set You scored 50 / 6083 % Charts for December » 7th PeriodFebruary You completed this image set You scored 48 / 6080 % Charts for February »

LevelNo. times Presented as correct No. times answered correctly % times answered correctly No. times Overgraded % of times Overgraded No. of times Undergraded % of times Undergraded R %1 3 %9 30 % R0000 %0 R1 - 0 R2 - 0 R %0 0 R %1 R2 - 0 R %4 R % R25240 %0 R %3 R0 - 0 R % R38675 %0 02 R0 - 0 R1 - 1 R % M %2 7 %1 3 % M %2 M %0 0 M18788 %0 01 M %

Period September EQA Grade R0R1M0R1M1R2M0R2M1R3M0R3M1 R R1M R1M R2M R2M R3M R3M

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