Diabetic Retinal Screening, Grading, Monitoring and Referral Guidance. Objective

Transcription

1 Diabetic Retinal Screening, Grading, Monitoring and Referral Guidance. Objective The Diabetic Retinal Grading, Monitoring and Referral Guidance 2015 updates all previous guidelines And outlines the key components of an organised diabetic retinal screening service so that high-quality, equitable screening can be provided for all those at risk of diabetic eye disease. It represents a statement of best practice, based on stakeholder consultation, evidence and is intended to guide the delivery of a nationally consistent programme. 1

2 Key Issues a revised three year screening interval for those without clinical modifiers and for those with no diabetic retinopathy detected an updated retinal screening pathway pupil dilation as a choice to be discussed with the person being screened coverage assurance for all people with diabetes screening of pregnant women in the first trimester a stronger focus on improved control including self management if retinopathy progresses timely re-screening if control deteriorates 2

3 Systems monitoring by optometrists with each region having a central coordinator for its diabetic retinopathy screening service based on national standards and oversight of the programme by an ophthalmologist the general practice as the health care home for the person with diabetes which includes access to electronic information and ensures enrolment with the screening programme especially when patients shift between DHBs Screening and monitoring results are provided within three weeks to the person with diabetes, their GP and their referring clinician 3

4 Pregnancy increases the risk of developing diabetic retinopathy (DR) and the rate of its progression. It is essential that retinal screening referrals are undertaken when women with known diabetes (type 1 or type2 )become pregnant. They should be screened in the first trimester. If a pregnant woman is not known to have diabetes, but has an HbA1c of 50 mmol/mol or greater when booking their antenatal blood tests they are likely to have had diabetes at conception. These women should also be screened in the first trimester or within four weeks of detecting their diabetes, and may need to be monitored during and after their pregnancy. Women who develop gestational diabetes after 20 weeks of pregnancy do not need to be screened. 4

5 Draft retinal screening indicators and measures Reporting is expected for the following indicators by July 2017 for baseline indicators and by July 2018 for those indicators needing new data. Screened population demographic data 1. Proportion of people with diabetes screened 2. All eligible people with diabetes should be screened, however, some may be under ophthalmology care or have co-morbidities preventing screening. It is expected that at least 90 percent of the population with diabetes PWD will be screened. 3. Timely assessment of risk for people newly diagnosed with type 2 diabetes 5

6 Draft retinal screening indicators and measures 4. Proportion of sight-threatening DR at first presentation 5. Assessment of screening process 6. Outcome grades 7. Retinal screening programme quality (additional DHB reporting) 8. Validity measures (national or regional level, beyond the screening programme) 6

7 Current reported coverage Retinal screening count in last 2 years European/Other Indian Mäori Pacific people Total Auckland Bay of Plenty Canterbury Capital and Coast Counties Manukau Hawkes Bay Hutt Lakes MidCentral Nelson Marlborough Northland South Canterbury Southern Tairawhiti Taranaki Unknown/Unassigned Waikato Wairarapa Waitemata West Coast Whanganui Total