In a new study, researchers found reported the results of the largest clinical trial for diabetic retinopathy.
The study highlights a new approach that could transform diabetic eye screening around the world that also has a significant cost saving.
The research was conducted by a team at the University of Liverpool.
The number of people living with diabetes in the world is over 460 million and is likely to rise to over 700 million in the next 35 years.
Diabetes affects the eye by damaging the blood vessels in the retina and is known as diabetic retinopathy.
The high blood sugar causes the fine blood vessels in the retina to leak fluid causing waterlogging or too close resulting in the retina becoming starved of oxygen.
Diabetic retinopathy (DR) is one of the commonest causes of visual loss in the world and can be prevented if it is detected early.
A person with DR isn’t aware of the problem until vision loss is so reduced that the patient notices, a stage when the damage is often irreversible.
Prompt laser treatment, injections of drugs into the eye or complex eye surgery are required to limit the damage.
In the study, the team tested whether a personalized approach to screening was more beneficial than the established yearly screening approach.
They recruited more than 4,500 patients over seven years.
Patients recruited to the study were either entered into a control group or a personalized or individualized, approach group.
The control group of patients continued to have their eyes screened every year to detect early changes of diabetic retinopathy, which is the current approach in most countries.
The individualized group underwent a novel, innovative screening method in which the time between each screening episode varied depending on the amount of retinopathy and the level of control of blood sugar, blood pressure, and cholesterol.
By combining all these important factors, the Liverpool system calculates the risk for each person using their own health information, the “individualized” approach.
Patients were then given six-month appointments if they were classed as at high risk of developing the sight-threatening disease, a 12-month appointment for medium risk, or a 24-month appointment for a low risk.
The results of the seven-year study showed that 81.9% of patients in the individualized group were deemed to be low-risk patients and therefore did not need to be screened every year.
This meant they only needed to attend an NHS appointment every two years, saving them time off work, travel costs, and inconvenience.
The team showed that 43.2% fewer appointments were required, releasing £27.2 million per year or £19.73 per patient per year. The study also found that there was a societal cost saving of £26.19 per patient per year.
The study also found that sight-threatening diabetic retinopathy was detected earlier in the high-risk people in the individualized group versus the control group and most importantly the safety of the patient was not compromised by longer screen intervals in the low-risk group.
One author of the study is Professor Simon Harding.
The study is published in Diabetologia.
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