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United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: Report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

Lookup NU author(s): James Talks



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. Aim: To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service. Methods: This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment. Results: 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58). Conclusions: This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

Publication metadata

Author(s): Denniston AK, Lee AY, Lee CS, Crabb DP, Bailey C, Lip P-L, Taylor P, Pikoula M, Cook E, Akerele T, Antcliff R, Brand C, Chakravarthy U, Chavan R, Dhingra N, Downey L, Eleftheriadis H, Ghanchi F, Khan R, Kumar V, Lobo A, Lotery A, Menon G, Mukherjee R, Palmer H, Patra S, Paul B, Sim DA, Talks JS, Wilkinson E, Tufail A, Egan CA

Publication type: Article

Publication status: Published

Journal: British Journal of Ophthalmology

Year: 2019

Volume: 103

Issue: 6

Pages: 837-843

Print publication date: 01/06/2019

Online publication date: 29/09/2018

Acceptance date: 07/07/2018

Date deposited: 15/10/2018

ISSN (print): 0007-1161

ISSN (electronic): 1468-2079

Publisher: BMJ Publishing Group


DOI: 10.1136/bjophthalmol-2018-312568


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Funder referenceFunder name
Department of Health's NIHR Biomedical Research Centre for Ophthalmology
Research to Prvent Blindness
UCL Insititute of Ophthalmology