Abstract
Aims
To report estimates of the prevalence of diabetic retinopathy (DR) and maculopathy grades for a large cohort of patients managed by the UK hospital eye service (HES).
Methods
Anonymised data were extracted from 30 UK NHS hospital trusts using a single ophthalmic electronic medical record (EMR) for the period from April 2000 to November 2010 to create the National Ophthalmology Database (NOD). From 2007, the EMR facilitated capture of a nationally agreed-upon standardised data set (DR Structured Assessment) relating to the presence or absence of clinical signs of DR and maculopathy. An algorithm in the software automatically calculated the Early Treatment of Diabetic Retinopathy Study grades of retinopathy and maculopathy.
Results
Between 2007 and 2010, 307 538 patients had data on the NOD, with 76 127 (24.8%) patients having been recorded as having diabetes. The proportion of patients with diabetes who had a structured assessment increased from 50.7% (2007) to 86.8% (2010). In each NHS year, 12.6–20.6% of eyes with structured assessments had no DR; 59.6–67.3% had non-proliferative DR; and 18.3–20.9% had active or regressed proliferative DR. Clinically significant macular oedema was present in 15.8–18.1% of eyes, and in 8.7–10.0% of eyes, this involved the central macula.
Conclusion
This study provides contemporary estimates of the prevalence of retinopathy and maculopathy grades in a large cohort of patients with diabetes managed by the UK HES. Centre-involving diabetic macular oedema, potentially amenable to anti-VEGF therapy, is present in the eyes of almost 10% of these patients. This information is useful for clinicians, health-care economists, and commissioners involved in planning and delivering diabetic eye services.
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Acknowledgements
The work of the National Ophthalmology Database received initial funding from the Department of Health via the NHS Diabetic Eye Screening Programme (formerly the English National Screening Programme for Diabetic Retinopathy) and is currently partly funded by The Royal College of Ophthalmologists. See appendix.
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RL Johnston is the medical director of Medisoft Limited, which developed the electronic medical record from which data were extracted for the first iteration of the National Ophthalmology Database, but no funding was provided by the company for this study. TDL Keenan has consulted for Alimera Sciences and received compensation.
Appendix
Appendix
Appendix Centres contributing to the NOD are listed below
Centres for which DR structured assessment data were available
Aintree Hospitals NHS Trust; Barking, Havering, and Redbridge University Hospitals NHS Trust; Bedford Hospital NHS Trust; Bradford Teaching Hospitals NHS Foundation Trust; Calderdale and Huddersfield NHS Foundation Trust; Cambridge University Hospitals NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; Epsom and St Helier University Hospitals NHS Trust; Frimley Park Hospital NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; Mid Cheshire Hospitals NHS Foundation Trust; Mid Yorkshire Hospitals NHS Trust; Royal Berkshire NHS Foundation Trust; Royal United Hospital Bath NHS Trust; South London Health-care NHS Trust; University Hospitals Bristol NHS Foundation Trust; Winchester and Eastleigh Health-care NHS Trust; Wirral University Teaching Hospital NHS Foundation Trust.
Centres for which DR structured assessment data were unavailable
Dumfries and Galloway Community Health NHS Trust; Grampian Health-care NHS Trust; King’s College Hospital NHS Trust; Nottingham University Hospital NHS Trust; Norfolk and Norwich University Hospitals NHS Foundation Trust; North Devon health-care NHS Trust; Peterborough and Stamford Hospitals NHS Foundation Trust; Portsmouth Hospitals NHS Trust; South Warwickshire NHS Foundation Trust; The Hillingdon Hospital NHS Trust; University Hospital Birmingham NHS Foundation Trust; University Hospital Of North Staffordshire NHS Trust.
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Keenan, T., Johnston, R., Donachie, P. et al. United Kingdom National Ophthalmology Database Study: Diabetic Retinopathy; Report 1: prevalence of centre-involving diabetic macular oedema and other grades of maculopathy and retinopathy in hospital eye services. Eye 27, 1397–1404 (2013). https://doi.org/10.1038/eye.2013.196
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DOI: https://doi.org/10.1038/eye.2013.196
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