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Zhang Y, Shi M, Peng D, Chen W, Ma Y, Song W, Wang Y, Hu H, Ji Z, Yang F. QiMing granules for diabetic retinopathy: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol 2024; 15:1429071. [PMID: 39239647 PMCID: PMC11374745 DOI: 10.3389/fphar.2024.1429071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024] Open
Abstract
Objective This study aimed to assess the efficacy and safety of QiMing granules (QM) in the treatment of patients with diabetic retinopathy (DR). Methods We systematically searched multiple databases, including Pubmed, Embase, Web of Science, Cochrane Library, SinoMed, Chinese National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database. Randomized controlled trials (RCTs) of QM in the treatment of DR were collected, and the search time limit was from the establishment of the database to 27 March 2024. Two independent researchers were involved in literature screening, data extraction, and bias risk assessment. The risk of bias in the included studies was assessed using the Risk of Bias Assessment tool for randomized controlled trials of Cochrane Collaboration 2.0 (RoB 2.0). The main outcomes were the overall efficacy, visual acuity, retinal circulation time, macular thickness. The secondary outcomes were the levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and glycated hemoglobin (HbA1c). The adverse events was considered the safety outcome. Review Manager 5.4.1 and Stata 15.1 were used for meta-analysis. Data were pooled by random-effects or fixed-effects model to obtain the mean difference (MD), risk ratio (RR), and 95% confidence interval (CI). Results A total of 33 RCTs involving 3,042 patients were included in this study. Overall, we demonstrated that QM had a significant clinical effect on DR. QM alone was superior to conventional treatment (CT) in terms of overall efficacy [RR = 1.45, 95% CI: (1.34, 1.58), p < 0.00001, moderate certainty], retinal circulation time [MD = -0.56, 95% CI: (-1.01, -0.12), p = 0.01] and macular thickness [MD = -11.99, 95% CI: (-23.15, -0.83), p = 0.04]. QM plus CT was superior to CT in terms of overall efficacy [RR = 1.29, 95% CI: (1.24, 1.33), p < 0.00001], visual acuity [MD = 0.14, 95% CI: (0.11, 0.17), p < 0.00001], macular thickness [MD = -14.70, 95% CI: (-21.56, -7.83), p < 0.0001], TG [MD = -0.20, 95% CI: (-0.33, -0.08), p = 0.001, moderate certainty], TC [MD = -0.57, 95% CI: (-1.06, -0.07), p = 0.02], and LDL-C [MD = -0.36, 95% CI: (-0.70, -0.03), p = 0.03]. In terms of safety, the incidence of adverse events in the experimental group was less than that in the control group. The results of the GRADE evidence quality evaluation showed that the evidence quality of outcome indicators was mostly low. Conclusion QM can effectively improve overall efficacy, visual acuity, macular thickness, retinal circulation time, and reduce the levels of TG, TC, and LDL-C. However, due to the limited number of studies included, a small sample size, and a lack of high-quality literature, the possibility of publication bias cannot be excluded. Moreover, biases are present due to differences in study design, such as the absence of placebo use in the control group and a predominant use of combined intervention designs in the control group, along with deficiencies in allocation concealment and blinding methods. Therefore, more multi-center, large-sample, and rigorously designed studies are needed to substantiate this conclusion. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023465165.
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Affiliation(s)
- Yazi Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Menglong Shi
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dehui Peng
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Weijie Chen
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yucong Ma
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wenting Song
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuetong Wang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haiyin Hu
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, China
| | - Zhaochen Ji
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Fengwen Yang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Gyawali R, Toomey M, Stapleton F, Ho KC, Keay L, Pye DC, Katalinic P, Liew G, Hsing YI, Ramke J, Gentle A, Webber AL, Schmid KL, Bentley S, Hibbert P, Wiles L, Jalbert I. Clinical indicators for diabetic eyecare delivered by optometrists in Australia: a Delphi study. Clin Exp Optom 2024; 107:571-580. [PMID: 37848180 DOI: 10.1080/08164622.2023.2253792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 10/19/2023] Open
Abstract
CLINICAL RELEVANCE Valid and updated clinical indicators can serve as important tools in assessing and improving eyecare delivery. BACKGROUND Indicators for diabetic eyecare in Australia were previously developed from guidelines published before 2013 and then used to assess the appropriateness of care delivery through a nationwide patient record card audit (the iCareTrack study). To reflect emerging evidence and contemporary practice, this study aimed to update clinical indicators for optometric care for people with type 2 diabetes in Australia. METHODS Forty-five candidate indicators, including existing iCareTrack and new indicators derived from nine high-quality evidence-based guidelines, were generated. A two-round modified Delphi process where expert panel members rated the impact, acceptability, and feasibility of the indicators on a 9-point scale and voted for inclusion or exclusion of the candidate indicators was used. Consensus on inclusion was reached when the median scores for impact, acceptability, and feasibility were ≥7 and >75% of experts voted for inclusion. RESULTS Thirty-two clinical indicators with high acceptability, impact and feasibility ratings (all median scores: 9) were developed. The final indicators were related to history taking (n = 12), physical examination (n = 8), recall period (n = 5), referral (n = 5), and patient education/communication (n = 2). Most (14 of 15) iCareTrack indicators were retained either in the original format or with modifications. New indicators included documenting the type of diabetes, serum lipid level, pregnancy, systemic medications, nephropathy, Indigenous status, general practitioner details, pupil examination, intraocular pressure, optical coherence tomography, diabetic retinopathy grading, recall period for high-risk diabetic patients without retinopathy, referral of high-risk proliferative retinopathy, communication with the general practitioner, and patient education. CONCLUSION A set of 32 updated diabetic eyecare clinical indicators was developed based on contemporary evidence and expert consensus. These updated indicators inform the development of programs to assess and enhance the eyecare delivery for people with diabetes in Australia.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - David C Pye
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Paula Katalinic
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Yan Inez Hsing
- Department of Optometry, Okko Eye Specialist Centre, Upper Mount Gravatt, Queensland, Australia
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Alex Gentle
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - Ann L Webber
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katrina L Schmid
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sharon Bentley
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
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Omar A, Williams RG, Whelan J, Noble J, Brent MH, Giunta M, Olivier S, Lhor M. Diabetic Disease of the Eye in Canada: Consensus Statements from a Retina Specialist Working Group. Ophthalmol Ther 2024; 13:1071-1102. [PMID: 38526804 DOI: 10.1007/s40123-024-00923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
Despite advances in systemic care, diabetic disease of the eye (DDE) remains the leading cause of blindness worldwide. There is a critical gap of up-to-date, evidence-based guidance for ophthalmologists in Canada that includes evidence from recent randomized controlled trials. Previous guidance has not always given special consideration to applying treatments and managing DDE in the context of the healthcare system. This consensus statement aims to assist practitioners in the field by providing a spectrum of acceptable opinions on DDE treatment and management from recognized experts in the field. In compiling evidence and generating consensus, a working group of retinal specialists in Canada addressed clinical questions surrounding the four themes of disease, patient, management, and collaboration. The working group reviewed literature representing the highest level of evidence on DDE and shared their opinions on topics surrounding the epidemiology and pathophysiology of diabetic retinopathy and diabetic macular edema; diagnosis and monitoring; considerations around diabetes medication use; strategic considerations for management given systemic comorbidities, ocular comorbidities, and pregnancy; treatment goals and modalities for diabetic macular edema, non-proliferative and proliferative diabetic retinopathy, and retinal detachment; and interdisciplinary collaboration. Ultimately, this work highlighted that the retinal examination in DDE not only informs the treating ophthalmologist but can serve as a global index for disease progression across many tissues of the body. It highlighted further that DDE can be treated regardless of diabetic control, that a systemic approach to patient care will result in the best health outcomes, and prevention of visual complications requires a multidisciplinary management approach. Ophthalmologists must tailor their clinical approach to the needs and circumstances of individual patients and work within the realities of their healthcare setting.
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Affiliation(s)
- Amer Omar
- Medical Retina Institute of Montreal, 2170 René-Lévesque Blvd Ouest, Bureau 101, Montréal, QC, H3H 2T8, Canada.
| | - R Geoff Williams
- Calgary Retina Consultants, University of Calgary, Calgary, AB, Canada
| | - James Whelan
- Faculty of Medicine, Memorial University, St. John's, NF, Canada
| | - Jason Noble
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, Canada
| | - Michel Giunta
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Sébastien Olivier
- Centre Universitaire d'ophtalmologie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mustapha Lhor
- Medical and Scientific Affairs Ophthalmology, Bayer Inc., Mississauga, ON, Canada
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Gurnani B, Kaur K. Re: Improving the patient decision making experience for cataract surgery during the COVID-19 era. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:505. [PMID: 37156475 PMCID: PMC10106816 DOI: 10.1016/j.jcjo.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol. Pilot Feasibility Stud 2023; 9:158. [PMID: 37689724 PMCID: PMC10492373 DOI: 10.1186/s40814-023-01372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. METHODS We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50-150 patients and 5-10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. DISCUSSION This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
- VITAM, Centre for Research On Sustainable Health, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, St. Michael's Hospital, Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- School of Psychology, University of Ottawa, Ottawa, Canada.
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Jacoba CMP, Salongcay RP, Rageh AK, Aquino LAC, Alog GP, Saunar AV, Peto T, Silva PS. Comparisons of Handheld Retinal Imaging with Optical Coherence Tomography for the Identification of Macular Pathology in Patients with Diabetes. Ophthalmic Res 2023; 66:903-912. [PMID: 37080187 DOI: 10.1159/000530720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Handheld retinal imaging cameras are relatively inexpensive and highly portable devices that have the potential to significantly expand diabetic retinopathy (DR) screening, allowing a much broader population to be evaluated. However, it is essential to evaluate if these devices can accurately identify vision-threatening macular diseases if DR screening programs will rely on these instruments. Thus, the purpose of this study was to evaluate the detection of diabetic macular pathology using monoscopic macula-centered images using mydriatic handheld retinal imaging compared with spectral domain optical coherence tomography (SDOCT). METHODS Mydriatic 40°-60° macula-centered images taken with 3 handheld retinal imaging devices (Aurora [AU], SmartScope [SS], RetinaVue 700 [RV]) were compared with the Cirrus 6000 SDOCT taken during the same visit. Images were evaluated for the presence of diabetic macular edema (DME) on monoscopic fundus photographs adapted from Early Treatment Diabetic Retinopathy Study (ETDRS) definitions (no DME, noncenter-involved DME [non-ciDME], and center-involved DME [ciDME]). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each device with SDOCT as gold standard. RESULTS Severity by ETDRS photos: no DR 33.3%, mild NPDR 20.4%, moderate 14.2%, severe 11.6%, proliferative 20.4%, and ungradable for DR 0%; no DME 83.1%, non-ciDME 4.9%, ciDME 12.0%, and ungradable for DME 0%. Gradable images by SDOCT (N = 217, 96.4%) showed no DME in 75.6%, non-ciDME in 9.8%, and ciDME in 11.1%. The ungradable rate for images (poor visualization in >50% of the macula) was AU: 0.9%, SS: 4.4%, and RV: 6.2%. For DME, sensitivity and specificity were similar across devices (0.5-0.64, 0.93-0.97). For nondiabetic macular pathology (ERM, pigment epithelial detachment, traction retinal detachment) across all devices, sensitivity was low to moderate (0.2-0.5) but highly specific (0.93-1.00). CONCLUSIONS Compared to SDOCT, handheld macular imaging attained high specificity but low sensitivity in identifying macular pathology. This suggests the importance of SDOCT evaluation for patients suspected to have DME on fundus photography, leading to more appropriate referral refinement.
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Affiliation(s)
- Cris Martin P Jacoba
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Recivall P Salongcay
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Centre for Public Health, Queen's University, Belfast, UK
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
| | - Abdulrahman K Rageh
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lizzie Anne C Aquino
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
| | - Glenn P Alog
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
| | - Aileen V Saunar
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
| | - Tunde Peto
- Centre for Public Health, Queen's University, Belfast, UK
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. The co-development of a linguistic and culturally tailored tele-retinopathy screening intervention for immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada. BMC Health Serv Res 2023; 23:302. [PMID: 36991464 PMCID: PMC10054218 DOI: 10.1186/s12913-023-09329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a sight-threatening ocular complication of diabetes. Screening is an effective way to reduce severe complications, but screening attendance rates are often low, particularly for newcomers and immigrants to Canada and people from cultural and linguistic minority groups. Building on previous work, in partnership with patient and health system stakeholders, we co-developed a linguistically and culturally tailored tele-retinopathy screening intervention for people living with diabetes who recently immigrated to Canada from either China or African-Caribbean countries. METHODS Following an environmental scan of diabetes eye care pathways in Ottawa, we conducted co-development workshops using a nominal group technique to create and prioritize personas of individuals requiring screening and identify barriers to screening that each persona may face. Next, we used the Theoretical Domains Framework to categorize the barriers/enablers and then mapped these categories to potential evidence-informed behaviour change techniques. Finally with these techniques in mind, participants prioritized strategies and channels of delivery, developed intervention content, and clarified actions required by different actors to overcome anticipated intervention delivery barriers. RESULTS We carried out iterative co-development workshops with Mandarin and French-speaking individuals living with diabetes (i.e., patients in the community) who immigrated to Canada from China and African-Caribbean countries (n = 13), patient partners (n = 7), and health system partners (n = 6) recruited from community health centres in Ottawa. Patients in the community co-development workshops were conducted in Mandarin or French. Together, we prioritized five barriers to attending diabetic retinopathy screening: language (TDF Domains: skills, social influences), retinopathy familiarity (knowledge, beliefs about consequences), physician barriers regarding communication for screening (social influences), lack of publicity about screening (knowledge, environmental context and resources), and fitting screening around other activities (environmental context and resources). The resulting intervention included the following behaviour change techniques to address prioritized local barriers: information about health consequence, providing instructions on how to attend screening, prompts/cues, adding objects to the environment, social support, and restructuring the social environment. Operationalized delivery channels incorporated language support, pre-booking screening and sending reminders, social support via social media and community champions, and providing using flyers and videos as delivery channels. CONCLUSION Working with intervention users and stakeholders, we co-developed a culturally and linguistically relevant tele-retinopathy intervention to address barriers to attending diabetic retinopathy screening and increase uptake among two under-served groups.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research On Sustainable Health, VITAM, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Gibbons CH, Giurini JM, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Sun JK, Gabbay RA, on behalf of the American Diabetes Association. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S203-S215. [PMID: 36507636 PMCID: PMC9810462 DOI: 10.2337/dc23-s012] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Umaefulam V, Premkumar K. Enablers and barriers to diabetic retinopathy eye care among first nations and Métis women. Diabet Med 2023; 40:e14995. [PMID: 36308051 DOI: 10.1111/dme.14995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 09/03/2022] [Accepted: 10/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diabetes is increasingly prevalent in Indigenous women and increases their risk of developing diabetic retinopathy, an eye complication of diabetes and a common cause of vision loss in Canada, especially among adults. Early detection is the most effective approach to prevent vision loss and reduce the impact of diabetic retinopathy. OBJECTIVE This study examined enablers and barriers that influence the diabetes eye care behaviour of First Nations and Métis women with diabetes and at risk of diabetes. METHODS We conducted a descriptive qualitative study with 35 First Nations and Métis women with diabetes or at risk of diabetes in Saskatoon, Canada. Data were collected via four sharing circle discussions and were analysed using thematic analysis. RESULTS The study findings showed that understanding of diabetes eye care access and cost, and unsupportive interactions with health care practitioners, were barriers to diabetic retinopathy care behaviour. Conversely, the presence of eye complications, participants' resolve to manage diabetes, self-efficacy and fear due to experiences of family members with diabetes enabled diabetes eye care. CONCLUSIONS Our study advances knowledge in socio-cultural factors influencing diabetic retinopathy care behaviour among First Nations and Métis women living with and at risk of diabetes. The study shows the need for further public health and health system interventions to address barriers and support Indigenous peoples with or at risk of diabetes to make informed health decisions.
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Affiliation(s)
- Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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11
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Umaefulam V, Premkumar K. Diabetic retinopathy awareness and eye care behaviour of indigenous women in Saskatoon, Canada. Int J Circumpolar Health 2021; 80:1878749. [PMID: 33491596 PMCID: PMC7850356 DOI: 10.1080/22423982.2021.1878749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/22/2020] [Accepted: 01/16/2021] [Indexed: 12/03/2022] Open
Abstract
Diabetes is a public health challenge in Canada with a disproportionate number of Indigenous people, especially women, living with diabetes. Diabetic retinopathy is a diabetes ocular complication and a common cause of blindness in Canadian adults. Many individuals living with diabetes do not have regular diabetic eye screening. This study sought to determine the diabetic retinopathy awareness and eye care behaviour of Indigenous women with diabetes or at risk of diabetes. This was a quantitative study among 78 Indigenous women (First Nations and Métis) in Saskatoon, Canada. Data on diabetic retinopathy awareness and eye care behaviour were collected via a knowledge, attitude, and practice survey. Participants had high diabetic retinopathy practice mean scores (32.16) than knowledge (30.16) and attitude scores (22.56). Sub-group analysis showed a significant difference in knowledge scores between age, education, and diabetes status, and differences in practice scores between age and education. Although our regression analysis indicated an association between education and knowledge scores (p = 0.024), and diabetes status and attitude scores (p = 0.044), the associations are not conclusive. Indigenous peoples with or at risk of diabetes may benefit from targeted interventions on diabetes and eye care, which could improve eye care awareness and behaviour.
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Affiliation(s)
- Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Gyawali R, Toomey M, Stapleton F, Zangerl B, Dillon L, Ho KC, Keay L, Alkhawajah SMM, Liew G, Jalbert I. Systematic review of diabetic eye disease practice guidelines: more applicability, transparency and development rigor are needed. J Clin Epidemiol 2021; 140:56-68. [PMID: 34487836 DOI: 10.1016/j.jclinepi.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/09/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the quality of diabetic eye disease clinical practice guidelines. STUDY DESIGN AND SETTING A systematic search of diabetic eye disease guidelines was conducted on six online databases and guideline repositories. Four reviewers independently rated quality using the Appraisal of Guidelines, Research, and Evaluation (AGREE II) instrument. Aggregate scores (%) for six domains and overall quality assessment were calculated. A "good quality" guideline was one with ≥60% score for "rigor of development" and in at least two other domains. RESULTS Eighteen guidelines met the inclusion criteria, of which 13 were evidence-based guidelines (involved systematic search and grading of evidence). The median scores (interquartile range (IQR)) for "scope and purpose," "stakeholder involvement," "rigor of development," "clarity of presentation," "applicability" and "editorial independence" were 73.6% (54.2%-80.6%), 48.6% (29.2%-71.5%), 60.2% (30.9%-78.1%), 86.6% (76.7%-94.4%), 28.6% (18.0%-37.8%) and 60.2% (30.9%-78.1%), respectively. The median overall score (out of 7) of all guidelines was 5.1 (IQR: 3.7-5.8). Evidence-based guidelines scored significantly higher compared to expert-consensus guidelines. Half (n = 9) of the guidelines (all evidence-based) were of "good quality." CONCLUSION A wide variation in methodological quality exists among diabetic eyecare guidelines, with nine demonstrating "good quality." Future iterations of guidelines could improve by appropriately engaging stakeholders, following a rigorous development process, including support for application in clinical practice and ensuring editorial transparency.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Australia; Better Vision Foundation Nepal, Kathmandu, Nepal.
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Lisa Dillon
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia; Singapore Eye Research Institute, Singapore
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Sally Marwan M Alkhawajah
- School of Optometry and Vision Science, UNSW Sydney, Australia; Department of Optometry and Vision Science, King Saud University, Riyadh, Saudi Arabia
| | - Gerald Liew
- Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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Begum T, Rahman A, Nomani D, Mamun A, Adams A, Islam S, Khair Z, Khair Z, Anwar I. Diagnostic Accuracy of Detecting Diabetic Retinopathy by Using Digital Fundus Photographs in the Peripheral Health Facilities of Bangladesh: Validation Study. JMIR Public Health Surveill 2021; 7:e23538. [PMID: 33411671 PMCID: PMC7988391 DOI: 10.2196/23538] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/01/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetic retinopathy can cause blindness even in the absence of symptoms. Although routine eye screening remains the mainstay of diabetic retinopathy treatment and it can prevent 95% of blindness, this screening is not available in many low- and middle-income countries even though these countries contribute to 75% of the global diabetic retinopathy burden. OBJECTIVE The aim of this study was to assess the diagnostic accuracy of diabetic retinopathy screening done by non-ophthalmologists using 2 different digital fundus cameras and to assess the risk factors for the occurrence of diabetic retinopathy. METHODS This validation study was conducted in 6 peripheral health facilities in Bangladesh from July 2017 to June 2018. A double-blinded diagnostic approach was used to test the accuracy of the diabetic retinopathy screening done by non-ophthalmologists against the gold standard diagnosis by ophthalmology-trained eye consultants. Retinal images were taken by using either a desk-based camera or a hand-held camera following pupil dilatation. Test accuracy was assessed using measures of sensitivity, specificity, and positive and negative predictive values. Overall agreement with the gold standard test was reported using the Cohen kappa statistic (κ) and area under the receiver operating curve (AUROC). Risk factors for diabetic retinopathy occurrence were assessed using binary logistic regression. RESULTS In 1455 patients with diabetes, the overall sensitivity to detect any form of diabetic retinopathy by non-ophthalmologists was 86.6% (483/558, 95% CI 83.5%-89.3%) and the specificity was 78.6% (705/897, 95% CI 75.8%-81.2%). The accuracy of the correct classification was excellent with a desk-based camera (AUROC 0.901, 95% CI 0.88-0.92) and fair with a hand-held camera (AUROC 0.710, 95% CI 0.67-0.74). Out of the 3 non-ophthalmologist categories, registered nurses and paramedics had strong agreement with kappa values of 0.70 and 0.85 in the diabetic retinopathy assessment, respectively, whereas the nonclinical trained staff had weak agreement (κ=0.35). The odds of having retinopathy increased with the duration of diabetes measured in 5-year intervals (P<.001); the odds of having retinopathy in patients with diabetes for 5-10 years (odds ratio [OR] 1.81, 95% CI 1.37-2.41) and more than 10 years (OR 3.88, 95% CI 2.91-5.15) were greater than that in patients with diabetes for less than 5 years. Obesity was found to have a negative association (P=.04) with diabetic retinopathy. CONCLUSIONS Digital fundus photography is an effective screening tool with acceptable diagnostic accuracy. Our findings suggest that diabetic retinopathy screening can be accurately performed by health care personnel other than eye consultants. People with more than 5 years of diabetes should receive priority in any community-level retinopathy screening program. In a country like Bangladesh where no diabetic retinopathy screening services exist, the use of hand-held cameras can be considered as a cost-effective option for potential system-wide implementation.
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Affiliation(s)
- Tahmina Begum
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | | | | | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | | | | | - Zara Khair
- The Fred Hollow Foundation, Dhaka, Bangladesh
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Diabetic Retinopathy Screening: A Systematic Review of Qualitative Literature. Can J Diabetes 2021; 45:725-733.e12. [PMID: 33814308 DOI: 10.1016/j.jcjd.2021.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Diabetic retinopathy is a common microvascular complication that leads to vision loss. Despite national and international organizations developing guidelines for diabetic retinopathy screening, patients with diabetes remain unscreened. Our aim was to understand facilitators and barriers influencing diabetic retinopathy screening attendance and to examine factors that promote program success. METHODS MEDLINE, Embase, PsycINFO and CINAHL from inception until September 23, 2019 were used for data collection. Studies were included if they were original qualitative research articles, included adults >18 years of age and assessed diabetic retinopathy screening programs or retinopathy screening as a component of a general diabetes care program. A "best-fit" framework synthesis methodology was used for this analysis. RESULTS Twenty-nine articles involving 1,433 participants were identified. Six themes of barriers to, and facilitators of, diabetic retinopathy screening were identified, including access to screening, knowledge and information sharing, training and skills competency, service delivery, cultural competency and psychological factors. Cost and competing interests were common barriers to access; lack of knowledge about screening services was also a frequently reported barrier. Both patients and providers identified the need for improved service delivery, especially the referral and follow-up process. Providers recognized the need for additional training, patients enumerated several psychological barriers to screening uptake and cultural considerations were believed to be important, particularly among indigenous communities. CONCLUSIONS To improve screening uptake, the identified challenges must be addressed while also reinforcing the facilitators. Furthermore, program administrators could model new and unsuccessful screening programs after the successful ones while also considering local peculiarities.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Campbell RJ, Sutherland R, Khan S, Doliszny KM, Hooper PL, Slater M, Frymire E, Shah BR, Walker JD, Green ME. Diabetes-induced eye disease among First Nations people in Ontario: a longitudinal, population-based cohort study. CMAJ Open 2020; 8:E282-E288. [PMID: 32303520 PMCID: PMC7207040 DOI: 10.9778/cmajo.20200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Canada, First Nations populations experience a higher incidence of diabetes and diabetes-related complications than other people. Given the paucity of information on use of preventive eye examinations and the need for interventional care for severe retinopathy among First Nations people, we carried out a population-based study to compare rates of eye examinations and interventional therapies to treat vision-threatening stages of diabetic retinopathy among First Nations people and other people with diabetes in Ontario. METHODS In collaboration with the Chiefs of Ontario, we carried out a population-based study to identify cohorts of First Nations people and other people with diabetes in Ontario from 1995/96 to 2014/15. We used linked health administrative databases to evaluate rates of eye examination (2005/06-2014/15) and severe diabetic retinopathy treatment and compared them between the 2 populations, and between First Nations people living in and outside of First Nations communities. RESULTS We identified 23 013 First Nations people and 1 364 222 other people diagnosed with diabetes from 1995/96 to 2014/15, of whom 49.8% (95% confidence interval [CI] 48.9%-50.7%) and 53.8% (95% CI 53.7%-54.0%), respectively, received an eye examination in 2014/15. Eye examination rates were similar for First Nations people regardless of whether they lived in or outside a First Nations community. First Nations people developed severe diabetic retinopathy at a faster rate than other people (hazard ratio 1.19, 95% CI 1.02-1.38). The gap between First Nations people and other people in the proportion requiring therapy for severe diabetic retinopathy was especially prominent among younger people. There were no significant differences in rates of diabetic retinopathy treatment in First Nations people stratified by place of residence. INTERPRETATION Eye examination rates remain suboptimal among people with diabetes in Ontario and were lower among First Nations people. This is particularly concerning in light of our other findings showing an increased risk of requiring treatment for advanced diabetic retinopathy and the accelerated rate of diabetic retinopathy progression among First Nations people with diabetes.
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Affiliation(s)
- Robert J Campbell
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.
| | - Roseanne Sutherland
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Shahriar Khan
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Katharine M Doliszny
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Philip L Hooper
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Morgan Slater
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Eliot Frymire
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Baiju R Shah
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Jennifer D Walker
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Michael E Green
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
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Alasqah A, Aldosari F, Almutaz A. Primary care physicians' knowledge, attitudes, and practices related to diabetic retinopathy in Buraidah city, Qassim region, Saudi Arabia. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_46_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Ho KC, Rahardjo D, Stapleton F, Wiles L, Hibbert PD, White AJR, Hayen A, Jalbert I. Can the appropriateness of eye care be measured through cross-sectional retrospective patient record review in eye care practices in Australia? The iCareTrack feasibility study. BMJ Open 2019; 9:e024298. [PMID: 30837251 PMCID: PMC6429871 DOI: 10.1136/bmjopen-2018-024298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The CareTrack study found that a wide range of appropriateness of care (ie, care in line with evidence-based or consensus-based guidelines) was delivered across many health conditions in Australia. This study therefore aimed to demonstrate the feasibility of using the CareTrack method (a retrospective onsite record review) to measure the appropriateness of eye care delivery. DESIGN Cross-sectional feasibility study. SETTING AND PARTICIPANTS Two hundred and thirteen patient records randomly selected from eight optometry and ophthalmology practices in Australia, selected through a combination of convenience and maximum variation sampling. METHODS Retrospective record review designed to assess the alignment between eye care delivered and 93 clinical indicators (Delphi method involving 11 experts) extracted from evidence-based clinical practice guidelines. PRIMARY OUTCOME MEASURE Number of eligible patient records, sampling rates and data collection time. This feasibility study also tested the ability of 93 clinical indicators to measure percentage appropriate eye care for preventative, glaucoma and diabetic eye care. A secondary outcome was the percentage of practitioner-patient encounters at which appropriate eye care was received. RESULTS A median of 20 records (range 9 to 63) per practice were reviewed. Data collection time ranged from 3 to 5.5 hours (median 3.5). The most effective sampling strategy involved random letter generation followed by sequential sampling. The appropriateness of care was 69% (95% CI 67% to 70%) for preventative eye care, 60% (95% CI 56% to 58%) for glaucoma and 63% (95% CI 57% to 69%) for diabetic eye care. CONCLUSIONS Appropriateness of eye care can be measured effectively using retrospective record review of eye care practices and consensus-based care indicators.
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Affiliation(s)
- Kam Chun Ho
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Dian Rahardjo
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Wiles
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Population Health Research, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Centre for Population Health Research, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Andrew J R White
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
- Centre for Vision Research, Westmead Millennium Institute, Sydney, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Luo Y, Zhu Y, Chen J, Gao X, Yang W, Zou X, Zhou X, Ji L. A Decision-Support Software to Improve the Standard Care in Chinese Type 2 Diabetes. J Diabetes Res 2019; 2019:5491743. [PMID: 31828162 PMCID: PMC6881560 DOI: 10.1155/2019/5491743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To develop a decision-support software according to the Chinese Diabetes Society guideline in order to improve the standard care in type 2 diabetes. METHODS Firstly, we developed a decision-support software for healthcare professionals. It was an independent software on a tablet to record the data of patients and treatments given by their physicians. A major function of the software was to remind doctors when and how they should implement the standard care as recommended by the Chinese Diabetes Society guideline. Secondly, we compared the baseline data of standard care including statin and aspirin usage with data from a previous "3B study" to see whether there was an improvement of these standard cares. Finally, we further compared the data during four quarters of the whole year to evaluate whether there was a continuous improvement. RESULTS During the first quarter, 27,291 cases and 27,352 cases were collected with complete information about statin and aspirin usage, respectively. The percentage of patients treated with statins and aspirin in our study was significantly higher than that reported in the 3B study (59.6% vs. 19.9% and 59.8% vs. 18.5%, P < 0.001). There were no significant differences among the four quarters for the percentage of the patients who were taking statin or aspirin (P > 0.05). CONCLUSION Our decision-support software has been shown to be effective in continuously improving the standardization of comprehensive treatment in type 2 diabetes.
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Affiliation(s)
- Yingying Luo
- Department of Endocrinology and Metabolism, Peking University People's Hospital, China
- Peking University Diabetes Center, Peking University Health Science Center, China
| | - Yongzan Zhu
- Academic Affair Department, Chinese Medical Association, China
| | - Jing Chen
- Department of Endocrinology and Metabolism, Peking University People's Hospital, China
- Peking University Diabetes Center, Peking University Health Science Center, China
| | - Xueying Gao
- Department of Endocrinology and Metabolism, Peking University People's Hospital, China
- Peking University Diabetes Center, Peking University Health Science Center, China
| | - Wenjia Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, China
- Peking University Diabetes Center, Peking University Health Science Center, China
| | - Xiantong Zou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, China
- Peking University Diabetes Center, Peking University Health Science Center, China
| | - Xianghai Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital, China
- Peking University Diabetes Center, Peking University Health Science Center, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, China
- Peking University Diabetes Center, Peking University Health Science Center, China
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Caron-Cantin M, Szoo A, Richer F. Diabetic retinopathy screening in the immigrant population of Quebec, Canada. Can J Ophthalmol 2018; 53:e215-e216. [PMID: 30502993 DOI: 10.1016/j.jcjo.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Marilou Caron-Cantin
- Faculty of Medicine, Biostatistics and Occupational Health, McGill University, Montreal, Que..
| | - Adam Szoo
- Consulting Analyst, Statistics Canada, Montréal, Que
| | - Faisca Richer
- Faculty of Medicine, Biostatistics and Occupational Health, McGill University, Montreal, Que.; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Que
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Boucher MC, El Yamani MEM. Urban diabetic retinopathy teleophthalmology screening: results and impact at the service corridor. Can J Ophthalmol 2018; 54:359-366. [PMID: 31109477 DOI: 10.1016/j.jcjo.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/04/2018] [Accepted: 06/13/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess real-world results and the impact on a hospital service corridor for screening for DR through an urban community teleophthalmology service. METHODS Retrospective analysis at the hospital service corridor of 148 diabetics referred to it following DR teleophthalmology screening of 1185 type II diabetics. RESULTS Of the screened diabetics, 87.4% (n = 1036) were exempted from face-to-face clinical examination (FFCE) in a traditional hospital eye care pathway and continued monitoring through teleophthalmology under a watch-and-wait attitude, while 12.5% (n = 148) were recommended for an FFCE. The FFCEs revealed that significant DR was present in 48.2% or in 5.6% of this screened diabetic population. Reasons for referral were findings of significant DR in 40.5%, of which diabetic macular edema (DME) represented 86.6%, other incidental significant sight-threatening findings represented 32.4% (4% of the screened diabetics), and insufficient image quality was obtained for the other 27.0%. Optical coherence tomography (OCT) imaging at FFCE confirmed DME in 26.4% and led to treatment. Patients referred for insufficient image quality showed significant pathology in 90.2%, of whom 63.4% underwent further monitoring or treatment. The readers requested the FFCEs for 148 patients within 1 month of the reading in 19.6%, 3 months in 26.3%, 4-12 months in 47.3%, and 12 months in 6.7% over the 34 months of the study. Compliance with FFCEs was 91.9%, absolute in 78.4% and relative in 21.5%. The availability of OCT at the imaging site would have impacted 4.5% of the screened diabetics by enabling teleophthalmology monitoring of 91.6%, identifying just-in-time interventions for DME treatments in 26.4% and reducing by 25% the need for referral of OCT-negative reader-identified DME. CONCLUSION The FFCEs generated at the hospital service corridor by an urban community DR screening teleophthalmology project did not impact negatively on its services; moreover, the service corridor was exempted from providing FFCEs to 87.4% of the diabetic population it serves. This study may help provide cost-efficiency indications for a screening protocol that would include OCT availability at the imaging site and measure its positive effects. While DR of which DME was the main cause of referral for FFCE, incidental significant sight-threatening findings were significant and approached DR as a cause of referral; this supports the recommendation of continued human intervention in DR teleophthalmology screening at this time and for this population, until automatic computer-aided diagnosis systems can recognise biomarkers associated with other significant fundus diseases. As a secondary gain this project benefited individuals in need of care who were lost to the traditional eye care pathway. Good compliance with the follow-up FFCE further supports teleophthalmology in its effort to provide better access to DR screening.
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Affiliation(s)
- Marie Carole Boucher
- Department of Ophthalmology, Université de Montréal; Ophthalmology University Center, Maisonneuve-Rosemont Hospital-Rosemont Hospital.
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Khan AM, Trope GE, Wedge R, Buys YM, El-Defrawy S, Chen Q, Jin YP. Policy implications of regional variations in eye disease detection and treatment on Prince Edward Island: a repeated cross-sectional analysis, 2010-2012. BMC Health Serv Res 2018; 18:273. [PMID: 29636054 PMCID: PMC5894155 DOI: 10.1186/s12913-018-3068-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/28/2018] [Indexed: 11/16/2022] Open
Abstract
Background In Canada, government insurance covers eye care services provided by ophthalmologists and other physicians. However, government coverage for services provided by optometrists, non-medical school trained primary eye care providers, varies regionally. Little is known about the impact of a funding model in which ophthalmologist services are government-insured but services provided by optometrists are not, on eye care utilization and eye disease detection and treatment. We aimed to address this question by examining geographic variations in eye care service utilization on Prince Edward Island (PEI). Methods PEI physician-billing data from 2010 to 2012 was analyzed across five distinct geographic regions (Charlottetown, Summerside, Prince, Queens & Kings and Stratford). The residential location of patients and practice locations of eye care providers were identified using the first three digits of their respective postal code. Age-standardized rates were computed for comparisons across different regions. Results There were six ophthalmologists practicing on PEI, five with offices in Charlottetown. Twenty optometrists practiced on the island with offices across the province. Stratford is closest and Prince farthest from Charlottetown. Age-standardized utilization rates of ophthalmologists per 100 populations were 10.44 in Charlottetown and 10.90 in Stratford, which was significantly higher than in other regions (7.74–8.92; p < 0.05). The disparities were most pronounced amongst the elderly. The prevalence of glaucoma visits was higher in Charlottetown (6.10%) and Stratford (6.38%) and lower in other regions. A similar pattern was observed for the prevalence of cataract visits. While the prevalence of diabetes visits was higher in Prince and Summerside, the utilization of ophthalmologists by people with diabetes was almost twice as high in Charlottetown (6.49%) than in Prince (3.88%). Conclusions The observed discrepancies in vision care utilization across geographic regions were likely attributed to barriers in accessing government-insured, geographically concentrated ophthalmologists, as opposed to a reflection of the true differences in eye disease occurrence. The lower prevalence of glaucoma visits in regions farther away from ophthalmologist offices may result in delayed detection and blindness in this population. Encouraging ophthalmologists to work in other areas of the province and/or to publicly fund services provided by optometrists may mitigate the observed disparities. Trial registration Not applicable.
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Affiliation(s)
- A M Khan
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - G E Trope
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, M5T 3A9, Canada
| | - R Wedge
- Health PEI, 16 Garfield Street, Charlottetown, PEI, C1A 7N8, Canada
| | - Y M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, M5T 3A9, Canada
| | - S El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, M5T 3A9, Canada
| | - Q Chen
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Y P Jin
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, M5T 3A9, Canada
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Kanjee R, Dookeran RI, Mathen MK, Stockl FA, Leicht R. Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba. Can J Ophthalmol 2017; 52 Suppl 1:S15-S18. [DOI: 10.1016/j.jcjo.2017.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/14/2016] [Accepted: 05/15/2016] [Indexed: 11/16/2022]
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O'Halloran RA, Turner AW. Evaluating the impact of optical coherence tomography in diabetic retinopathy screening for an Aboriginal population. Clin Exp Ophthalmol 2017; 46:116-121. [PMID: 28677229 DOI: 10.1111/ceo.13018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Optical coherence tomography is used routinely in management of diabetic eye disease but has not been evaluated in Australian outreach settings for screening programmes. BACKGROUND The study aims to evaluate the use of optical coherence tomography combined with a fundus camera compared with a fundus camera only in a telehealth diabetic retinopathy screening programme for Aboriginal Australians. DESIGN Retrospective comparative study was used. PARTICIPANTS The study included patients with diabetes at two Aboriginal Health Services. METHODS An intervention group was studied in 2015 using a Topcon 3D optical coherence tomography-1 Maestro combined with optical coherence tomography/fundus camera. A control group was studied in 2014 using a DRS non-mydriatic fundus camera. Fundus photographs were emailed to trained retinal graders for review. Optical coherence tomography scans were graded by ophthalmologists via remote TeamViewer access. MAIN OUTCOME MEASURE Referral rates to an eye health professional and the rate of inadequate photographs. RESULTS Two hundred and twenty-two patients were included, with 80 in the control group and 142 in the intervention group. There was a significantly higher rate of inadequate fundus photographs in the intervention group (31.0% vs. 13.8%). Although there was a higher rate of referral to an eye health professional in the intervention group (39.6% vs. 30.0%), this was not significant. Diabetic retinopathy and maculopathy was evident in 32.3% and 12.0% of adequate fundus photographs, respectively. Diabetic macular oedema was present in 3.6% of optical coherence tomography scans. CONCLUSIONS AND RELEVANCE The combined optical coherence tomography fundus camera provided no advantage for diabetic retinopathy screening compared with fundus photography in an Australian programme. The rate of referral to an eye health professional was not reduced with a higher rate of inadequate fundus photographs.
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Affiliation(s)
- Richard A O'Halloran
- Lions Outback Vision, Perth, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia
| | - Angus W Turner
- Lions Outback Vision, Perth, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia
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Hurley B. Therapeutic revolution in the management of diabetic retinopathy. Can J Ophthalmol 2017; 52 Suppl 1:S1-S2. [PMID: 29074003 DOI: 10.1016/j.jcjo.2017.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/13/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Bernard Hurley
- The University of Ottawa Eye Institute and the Ottawa Hospital, Ottawa, Ont.
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Corticosteroidi per via Intravitreale per il Trattamento Dell'edema Maculare: Revisione e Valutazione Della Qualità Dell'evidenza. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2017. [DOI: 10.5301/grhta.5000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hwang J, Rudnisky C, Bowen S, Johnson JA. Income-related inequalities in visual impairment and eye screening services in patients with type 2 diabetes. J Public Health (Oxf) 2016; 38:e571-e579. [PMID: 28158837 PMCID: PMC5939642 DOI: 10.1093/pubmed/fdv185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective We aimed to measure income-related inequalities in visual impairment and use of eye screening services amongst Canadian living with type 2 diabetes, and to examine contribution of various socio-demographic factors to identified income-related inequalities. Methods We used data from the Survey on Living with Chronic Disease in Canada-Diabetes Component 2011 (SLCDC-DM) to derive the relative concentration index (RCI) and decomposition of the RCI. Results Individuals with lower income tended to have more visual impairment compared with those with higher income. The main contribution to the observed income inequality in visual impairment came from age and marital status. Regarding eye screening services, patients with higher income were more likely to use eye screening and preventive eye screening services. The main contributors to increased use were income, having private health insurance and patient's experience in discussing diabetic complications with health professionals. Conclusion Identified contributors of income-related inequality should be considered when health and healthcare policies are developed in order to minimize and mitigate the observed inequalities.
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Affiliation(s)
- Jongnam Hwang
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, CanadaM5B 1W8
| | - Christopher Rudnisky
- Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, CanadaT5H 3V9
| | - Sarah Bowen
- School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, ON, CanadaK1H 8M5
| | - Jeffrey A. Johnson
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, CanadaT6G 2E1
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Gabriele Schorr S, Hammes HP, Alfons Müller U, Abholz HH, Landgraf R, Bertram B. The Prevention and Treatment of Retinal Complications in Diabetes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:816-823. [PMID: 28073426 PMCID: PMC5241793 DOI: 10.3238/arztebl.2016.0816] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 07/25/2016] [Accepted: 09/05/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Microvascular complications of diabetes mellitus can cause retino pathy and maculopathy, which can irreversibly damage vision and lead to blindness. The prevalence of retinopathy is 9-16% in patients with type 2 diabetes and 24-27% in patients with type 1 diabetes. 0.2-0.5% of diabetics are blind. METHODS The National Disease Management Guideline on the prevention and treatment of retinal complications in diabetes was updated according to recommendations developed by seven scientific medical societies and organizations and by patient representatives and then approved in a formal consensus process. These recommendations are based on international guidelines and systematic reviews of the literature. RESULTS Regular ophthalmological examinations enable the detection of retinopathy in early, better treatable stages. The control intervals should be based on the individual risk profile: 2 years for low-risk patients and 1 year for others, or even shorter depending on the severity of retinopathy. General risk factors for retinopathy include the duration of diabetes, the degree of hyperglycemia, hypertension, and diabetic nephropathy. The general, individually adapted treatment strategies are aimed at improving the risk profile. The most important specifically ophthalmological treatment recommendations are for panretinal laser coagulation in proliferative diabetic retinopathy and, in case of clinically significant diabetic macular edema with foveal involvement, for the intravitreal application of medications (mainly, vascular endothelial growth factor [VEGF] inhibitors), if an improvement of vision with this treatment is thought to be possible. CONCLUSION Regular, risk-adapted ophthalmological examinations, with standardized documentation of the findings for communication between ophthalmologists and the patients' treating primary care physicians/diabetologists, is essential for the prevention of diabetic retinal complications, and for their optimal treatment if they are already present.
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Kanjee R, Dookeran RI, Mathen MK, Stockl FA, Leicht R. Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba. Can J Ophthalmol 2016; 51:467-470. [PMID: 27938959 DOI: 10.1016/j.jcjo.2016.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/14/2016] [Accepted: 05/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the diabetic retinopathy (DR) tele-ophthalmology screening program in Manitoba to determine prevalence and incidence of DR, as well as to estimate the program's cost-effectiveness. DESIGN Retrospective chart review. PARTICIPANTS A total of 4676 patients with type 2 diabetes examined 9334 times from 2007 to 2013. METHODS Focused ophthalmic histories were recorded and examinations were performed by trained nurses, including visual acuities, intraocular pressure, and mydriatic 7 standard field stereoscopic fundus photography. Images were evaluated by retinal specialists according to the Early Treatment of Diabetic Retinopathy Study criteria. DR prevalence and incidence were then calculated during the study period. Cost-effectiveness was estimated by comparing the cost of running the tele-ophthalmology program compared with the cost of screening the same volume of patients in-office. RESULTS The average prevalence of any DR in each year was 25.1%. The cumulative incidence of DR across 6 years was 17.1% (95% CI, 15.4%-18.7%). The average savings per tele-ophthalmology examination was $1007. CONCLUSIONS DR is highly prevalent among the studied population. Tele-ophthalmology provides a cost-effective means of monitoring patients as well as identifying new or treatable disease.
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Affiliation(s)
- Raageen Kanjee
- Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba..
| | - Ravi I Dookeran
- Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Mathen K Mathen
- Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Frank A Stockl
- Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Richard Leicht
- Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba
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Romero-Aroca P, de la Riva-Fernandez S, Valls-Mateu A, Sagarra-Alamo R, Moreno-Ribas A, Soler N, Puig D. Cost of diabetic retinopathy and macular oedema in a population, an eight year follow up. BMC Ophthalmol 2016; 16:136. [PMID: 27491545 PMCID: PMC4973531 DOI: 10.1186/s12886-016-0318-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 08/01/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prospective, population-based study of an 8-year follow up. To determine the direct cost of diabetic retinopathy [DR], evaluating our screening programme and the cost of treating DR, focusing on diabetic macular oedema [DMO] after anti-vascular endothelial growth factor [anti-VEGF] treatment. METHODS A total of 15,396 diabetes mellitus [DM] patients were studied. We determined the cost-effectiveness of our screening programme against an annual programme by applying the Markov simulation model. We also compared the cost-effectiveness of anti-VEGF treatment to laser treatment for screened patients with DMO. RESULTS The cost of our 2.5-year screening programme was as follows: per patient with any-DR, €482.85 ± 35.14; per sight-threatening diabetic retinopathy [STDR] patient, €1528.26 ± 114.94; and €1826.98 ± 108.26 per DMO patient. Comparatively, an annual screening programme would result in increases as follows: 0.77 in QALY per patient with any-DR and 0.6 and 0.44 per patient with STDR or DMO, respectively, with an incremental cost-effective ratio [ICER] of €1096.88 for any-DR, €4571.2 for STDR and €7443.28 per DMO patient. Regarding diagnosis and treatment, the mean annual total cost per patient with DMO was €777.09 ± 49.45 for the laser treated group and €7153.62 ± 212.15 for the anti-VEGF group, with a QALY gain of 0.21, the yearly mean cost was €7153.62 ± 212.15 per patient, and the ICER was €30,361. CONCLUSIONS Screening for diabetic retinopathy every 2.5 years is cost-effective, but should be adjusted to a patient's personal risk factors. Treatment with anti-VEGF for DMO has increased costs, but the cost-utility increases to 0.21 QALY per patient.
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Affiliation(s)
- Pedro Romero-Aroca
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain
- Hospital Universtario Sant Joan, Avenida. Doctor. Josep Laporte 2, 43204 Reus, Spain
| | - Sofia de la Riva-Fernandez
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain
| | - Aida Valls-Mateu
- Department of Computer Engineering and Mathematics, University Rovira and Virgili, Reus, Spain
| | - Ramon Sagarra-Alamo
- Health Care Area Reus-Priorat, Reus, Spain
- Institut Catala de la Salut [ICS], Barcelona, Spain
- Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain
| | - Antonio Moreno-Ribas
- Department of Computer Engineering and Mathematics, University Rovira and Virgili, Reus, Spain
| | - Nuria Soler
- Ophthalmology Service, University Hospital Sant Joan, Institut de Investigacio Sanitaria Pere Virgili [IISPV], University Rovira and Virgili, Reus, Spain
| | - Domenec Puig
- Department of Computer Engineering and Mathematics, University Rovira and Virgili, Reus, Spain
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Abstract
The prevalence of diabetes is on the rise globally as are the consequences, such as diabetic retinopathy. Diabetic retinopathy is a leading cause of vision loss in working-age adults in developed countries. Visual impairment as a result of diabetic retinopathy has a significant negative impact on the patient's quality of life and their ability to successfully manage their disease. Glycemic control, blood pressure normalization, and lipid management form the basis for long-term diabetes management and protection from worsening eye disease.
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Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, Waugh N. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Health Technol Assess 2016; 19:v-xxviii, 1-247. [PMID: 26173799 DOI: 10.3310/hta19510] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR). OBJECTIVES The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP? ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) for efficacy but other designs also used. DATA SOURCES MEDLINE and EMBASE to February 2014, Web of Science. REVIEW METHODS Systematic review and economic modelling. RESULTS The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO. LIMITATION The current evidence is insufficient to recommend PRP for severe NPDR. CONCLUSIONS There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005408. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Pamela Royle
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Auguste
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Deepson Shyangdan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Norman Waugh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Decomposing socioeconomic inequalities in the use of preventive eye screening services among individuals with diabetes in Korea. Int J Public Health 2016; 61:613-20. [DOI: 10.1007/s00038-016-0804-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 02/08/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022] Open
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Sonron EA, Tripathi V, Bridgemohan P, Sharma S. A retrospective study on the outcomes of cataract surgery in an Eastern Regional Health Authority hospital of Trinidad and Tobago. PeerJ 2015; 3:e1222. [PMID: 26357596 PMCID: PMC4562237 DOI: 10.7717/peerj.1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/09/2015] [Indexed: 02/04/2023] Open
Abstract
Background. Worldwide, cataract is a major cause of blindness. The paper aims to evaluate factors associated with borderline and poor outcomes of cataract surgery at an Eastern Regional Health Authority (ERHA) hospital in Trinidad and Tobago. Materials and Methods. A hospital-based, retrospective study was done on 401 patients who had undergone cataract surgery (unilateral and bilateral) at an ERHA Hospital between March 2009 and September 2014. Data was collected on variables concerning demographic, medical history, surgical history, ocular findings and visual acuity (VA). The outcome variable of interest was Snellen's post-operative (presenting) VA which was transformed into a dichotomous variable with borderline and poor outcomes as one and good outcomes as the other. Data were analysed using univariate and multivariate logistic regression analyses. Results. Good outcome (presenting VA 6/18 or better) was seen in 350 (67%) eyes. The fitted model consisted of ocular co-morbidity (OR =2.133; 95% CI [1.346-3.380]), hypertension (OR = 0.520; 95% CI [0.381-0.928]), surgical procedure (OR = 1.56; 95% CI [1.004-2.425]), good preoperative VA (OR = 0.388, 95% CI [0.211-0.714]), borderline preoperative VA (OR = 0.485; 95% CI = [0.278-0.843]) and year of first visit to clinic (OR = 2.243; 95% CI [1.215-4.141]). Conclusion. There is a need for community-based outreach to increase awareness of eye health and diseases. It is recommended that the general population is encouraged to take responsibility for personal management. The facilities at the Hospital should also be enhanced.
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Affiliation(s)
- Ebiakpo-aboere Sonron
- Department of Mathematics & Statistics, Faculty of Science and Technology, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vrijesh Tripathi
- Department of Mathematics & Statistics, Faculty of Science and Technology, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Petra Bridgemohan
- Ophthalmology Department, Sangre Grande Hospital, Eastern Regional Health Authority, Trinidad and Tobago
| | - Subash Sharma
- School of Optometry and Visual Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Abstract
Diabetes is the leading cause of end-stage renal disease, blindness, and nontraumatic lower-limb amputation. The largest reductions in cardiovascular events are seen when multiple risk factors are addressed simultaneously. The benefit of aspirin as secondary prevention in patients with previous stroke or myocardial infarction has been well established. Regular, dilated eye examinations are effective in detecting sight-threatening diabetic retinopathy and have been shown to prevent blindness. The use of appropriate tools and clinical examination/inspection provides greater than 87% specificity in detecting diabetic peripheral neuropathy. Early treatment of risk factors, including hypertension, hyperglycemia, and dyslipidemia can delay or prevent diabetic nephropathy.
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Affiliation(s)
- Matthew P Gilbert
- Division of Endocrinology and Diabetes, Department of Medicine, College of Medicine, The University of Vermont, 62 Tilley Drive, South Burlington, VT 05403, USA.
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Hooper P, Boucher MC, Colleaux K, Cruess A, Greve M, Lam WC, Shortt S, Tourville E. Contemporary Management of Diabetic Retinopathy in Canada: From Guidelines to Algorithm Guidance. Ophthalmologica 2013; 231:2-15. [DOI: 10.1159/000354548] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 06/26/2013] [Indexed: 11/19/2022]
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