News Release

When to screen for diabetic eye disease?

NB. Please note that if you are outside North America, the embargo for LANCET press material is 0001 hours UK Time Friday 17 January 2003

Peer-Reviewed Publication

The Lancet_DELETED

Worldwide debate about how often to screen patients for diabetes-related eye disease is given clarification in this week's issue of THE LANCET. A UK study which involved over 7500 patients provides an evidence base for the incidence of diabetic eye disease and also proposes recommendations for the frequency of screening.

Diabetic retinopathy - damage to retinal cells in the eye associated with diabetes - is one of the leading causes of sight loss in developed countries. The frequency of screening in programmes to detect early-stage disease is not uniform worldwide and is currently based on expert opinion rather than evidence-based research. Led by Naveed Younis from the Royal Liverpool University Hospital, UK, the Liverpool Diabetic Eye Study assessed the incidence of sight-threatening diabetic retinopathy in patients with type 2 diabetes, using the results to calculate optimum screening intervals according to the stage of eye disease at first examination.

Around 7600 patients from 100 general practices took part in the study. Retinal examination was done by photography. The incidence of sight-threatening diabetic retinopathy in the first year after examination varied from 0.3% for patients with no baseline retinopathy to 15% for patients with moderate disease at first examination. Using the incidence data, the investigators proposed the following screening intervals, which would give 95% certainty of not missing sight-threatening retinopathy; no retinopathy - 3 years; no retinopathy with either insulin use or disease duration longer than 20 years - 1 year; background retinopathy - 1 year; and mild preproliferative retinopathy - 4 months.

Simon Harding, one of the investigators, comments: "Our findings from Liverpool give new evidence to allow screening programmes worldwide to decide on the optimum screening intervals. This is especially topical in the UK where the national screening programmes are being established - approval from the government has been received this month for the introduction of screening throughout England and Wales. 70% of people with diabetes in a screening programme have no retinopathy and so a longer screen interval should result in greater cost-effectiveness."

An accompanying Commentary (p 190) by Ronald Klein from the University of Wisconsin, USA, calls for additional research to confirm the findings of the Liverpool study. Ronald Klein concludes: "Before adopting new guidelines for intervals for retinal examination in persons with type 2 diabetes, effectiveness in achieving a significant reduction in vision loss from diabetes at least similar to that achieved by routine yearly dilated-eye examinations should be demonstrated."

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