Tag: retinopathy

RNIB Scotland: It is more important than ever that people with diabetes attend their regular eye-examinations

As the covid crisis eases, the national sight loss charity RNIB Scotland is emphasising it is more important than ever that people with diabetes attend their regular eye-examinations now that these have resumed.

During Diabetes Week this week [June 13-19th], the charity is pointing out that diabetic retinopathy, a complication of the condition, is a leading cause of sight loss among working-age Scots.

Director James Adams said: “Diabetic retinopathy, a complication of diabetes, can affect the small blood vessels at the back of the eye and is a major cause of sight loss among working-age adults. But damage to vision can be arrested if detected early enough.

“While it’s possible that diabetes won’t cause any changes to your vision, the most effective thing you can do to prevent sight loss is to go to your retinal screening appointments and eye examinations, where safety measures are in place.”

Each year, 5,500 patients with diabetes in Scotland need to undergo further imaging or see an NHS eye specialist for the first time due to worsening in their retinopathy.

Angela Clelland, 47, from Inverness received a diagnosis of diabetic retinopathy during lockdown.

“Getting diagnosed was very, very scary,” Angela said, “because I was isolated in the pandemic. If you are on your own, it affects everything from simple things like making a cup of tea, having the confidence to go out, or not being able to check your diabetes because you can’t read the monitor.

“You need to take your eye health seriously. You need to make sure that you are going for your eye health checks. Even with the slightest change, go to your optician. As things were delayed due to COVID, I would urge anybody who is maybe late or due an appointment to go and make one, because the effect on your life if you don’t go and something happens is devastating.”

There are 3.5 million people in the UK who have been diagnosed diabetes, and an estimated 500,000 people living with undiagnosed diabetes. Within 20 years of diagnosis, nearly all people with type 1 diabetes and almost two-thirds of people with type 2 diabetes will have developed some form of diabetic retinopathy. People with diabetes are also at increased risk of glaucoma and cataracts.

People from a South Asian or African-Caribbean background are two to four times more likely to get type 2 diabetes. They tend to develop it at a younger age which means they live with the condition for longer.

The risk of complications increases with the length of time people have the condition. It is not known why this is the case, but it is likely to be a mixture of genetics, lifestyle, and environmental factors.

* If you’re worried about your vision, contact RNIB’s Sight Loss Advice Service on 0303 123 9999 or visit www.rnib.org.uk/eyehealth. 

For more information on the NHS Scotland eye-screening service, visit:

https://www.nhsinform.scot/illnesses-and-conditions/diabetes/diabetic-retinopathy.

Clinical trial provides new approach for people with eye disease to increase NHS capacity

A UK-wide study, led by Queen’s University Belfast, has shown how a new surveillance pathway for people with stable diabetic eye disease is safe and cost-saving, freeing up ophthalmologists to evaluate and treat people requiring urgent care. 

The new health care surveillance pathway may help ophthalmic units across the world to improve their capacity whilst saving patient’s sight. It is already having a positive impact on the re-design of NHS services across the UK, having been implemented successfully in several hospitals. 

The research, funded by the National Institute for Health Research (NIHR), has been published in leading journals including Ophthalmology, BMJ and NIHR’s Health Technology Assessment. 

The EMERALD (the Effectiveness of Multimodal imaging for the Evaluation of Retinal oedemA and new VesseLs in Diabetic retinopathy) diagnostic accuracy study tested a new “ophthalmic grader” pathway. Rather than ophthalmologists, this pathway involves trained graders monitoring people with previously treated and stable complications of diabetic eye disease, namely diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR), based on the reading of images and scans of the back of their eyes.  

The grader’s pathway can save £1390 per 100 patients, and the real savings are the ophthalmologist’s time, which can then be redirected to the evaluation of people at high risk of visual loss. 

Professor Noemi Lois, lead researcher and Clinical Professor of Ophthalmology from the Wellcome-Wolfson Institute for Experimental Medicine at Queen’s University Belfast, explains: “Diabetic macular oedema and proliferative diabetic retinopathy, the main sight-threatening complications of diabetic retinopathy can cause blindness if left untreated. It is therefore important to diagnose them and to treat them timely.

“NHS hospitals eye units are under significant pressure given the extremely high number of people that need to be examined and treated and given the insufficient number of ophthalmologists in the UK. Currently, ophthalmologists need to evaluate all patients, even those that are stable after treatment and who are doing well.” 

In EMERALD, trained ophthalmic graders were found to achieve satisfactory results when compared to standard care (i.e., ophthalmologists evaluating patients in clinic) while releasing ophthalmologist’s time. 

Professor Lois added: “EMERALD showed trained ophthalmic graders are able to determine whether patients with diabetic macular oedema or proliferative diabetic retinopathy previously successfully treated remain stable or if on them the disease has reactivated.  

“Thus, they would be able to follow people that have been already treated, releasing ophthalmologists’ time. Ophthalmologists could then use this time to treat timely other patients, for example, those who have indeed diabetic macular oedema or active proliferative diabetic retinopathy and who have not yet received treatment saving their sight.” 

Dr Clare Bailey, consultant ophthalmologist at the Bristol Eye Hospital, said: “The important data from the EMERALD study has helped us to significantly increase the numbers of people with diabetic retinopathy being seen in ‘imaging/grading’ pathways.

“This has hugely increased our follow-up capacity, whilst allowing ophthalmologists’ time to be directed to the people with diabetic retinopathy who need treatment or further assessment. 

“This has helped us to deal with the capacity pressures as a result of Covid -19 as well as the longer-term capacity demands due to the increasing prevalence of diabetic retinopathy.” 

Dr Caroline Styles, Consultant Ophthalmologist with NHS Fife, added: “Emerald provided us in NHS Fife with the relevant evidence that allowed us to redesign our pathways for people with diabetic eye disease.

“The involvement of people with diabetes in this study reassures our population that these are safe and appropriate changes, and not just based on cost.” 

The EMERALD study was set in 13 National Health Service (NHS) hospitals across the UK and is a large multicentric, UK-wide, National Institute for Health Research (NIHR)-funded diagnostic accuracy study.