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Grading and disease management in national screening for diabetic retinopathy in England and Wales

Lookup NU author(s): Professor Roy Taylor

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Abstract

Aims: A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight-threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false-positive referral to the hospital eye service. Methods: Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications. Proposals: Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no 'questionable' lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight-threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight-threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1). Discussion: The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality-assured screening for people with diabetes. © 2003 Diabetes UK.


Publication metadata

Author(s): Harding S, Greenwood R, Aldington S, Gibson J, Owens D, Taylor R, Kohner E, Scanlon P, Leese G

Publication type: Article

Publication status: Published

Journal: Diabetic Medicine

Year: 2003

Volume: 20

Issue: 12

Pages: 965-971

Print publication date: 01/12/2003

ISSN (print): 0742-3071

ISSN (electronic): 1464-5491

Publisher: Wiley-Blackwell Publishing

URL: http://dx.doi.org/10.1111/j.1464-5491.2003.01077.x

DOI: 10.1111/j.1464-5491.2003.01077.x

PubMed id: 14632697


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