Feasibility of an alternative pathway for hospital referrals from Diabetic Eye Screening Wales (DESW) for people suspected with sight-threatening diabetic eye disease (diabetic maculopathy).
Aim(s) and objective(s) of the research: To assess a primary care based opticians pathway involving virtual review by a consultant ophthalmologist, in the assessment of suspected diabetic maculopathy. Does this pathway work and is it acceptable to people with diabetes, and at what cost?
Background: Diabetic eye disease (DED) is a common and feared complication of diabetes which includes both diabetic retinopathy and diabetic maculopathy (fluid build-up affecting the central retina at the back of the eye). In 2020, of 103 million people worldwide with DED, 29 million had vision-threatening DED and 19 million had diabetic macular oedema, which is expected to increase to 161 million, 45 million and 29 million respectively by 2045 [4].
Screening by Diabetic Eye Service Wales (DESW) currently involves taking 2-D (dimensional) digital photographs of the back of the eye (retina), which are then graded. Leakage from damaged capillaries can cause swelling within the central part of the retina (diabetic maculopathy). However, this thickness cannot be seen on traditional 2-D images. Not everyone with diabetic retinopathy has maculopathy. A diagnosis of maculopathy requires a 3-D camera via a technique known as Optical Coherence Tomography (OCT). The OCT is not part of the routine screening but, is available in Hospital Eye Clinics and many optician practices. If any changes are seen in the macular region on 2-D images, the patient requires an OCT scan to see if there is any increased thickness. Many patients do not have increased thickness. Currently after screening, in those patients with macular changes suggestive of diabetic maculopathy, they are referred to the Hospital Eye Clinic (HES) for OCT imaging. Many of these patients will not have increased thickness and the appointment could have been better utilised seeing a different patient with increased thickness that requires treatment.
What you hope to discover: The new pathway involves optician practices who have an OCT camera to take the required images and carry out the initial examination. This information will be then be reviewed by an ophthalmologist virtually to decide the management plan.
If this pathway is safe and acceptable to people with diabetes, it would reduce the pressure on HES clinics. It will also develop new skills for opticians and allow people to be seen closer to their home, reducing the stress referrals can create.
Public involvement: This study has been reviewed by three members of the long-standing diabetes research group public reference panel who have had input into the study design. They felt that this was an important study and could help people referred from the DESW for further assessment and/or treatment. A member of the reference panel is a co-applicant on this application and there will be two additional members of the panel on the study steering committee and so will be involved in the further developing, running, monitoring, assessing and disseminating the results of the study.
Dissemination: The findings from this study will be reported to our public reference group, and Public Health Wales, with manuscripts submitted for publication in peer reviewed journals. Presentations at related local, national, and international meetings/conferences will also be undertaken.