Addressing Disparities in Diabetic Eye Care

Diabetic Retinopathy is a common eye problem that affects people with diabetes and can lead to vision loss. It is a big concern worldwide. Thankfully, if caught early, treatment can help prevent or slow down sight loss.

In the UK, the NHS set up the Diabetic Eye Screening Programme (DESP) in 2003 to identify people with diabetic retinopathy so they can get the care they need. Currently, this program carries out about 2.3 million eye Screenings every year, resulting in around 13 million retinal images taken. Over the years, the number of screenings and images has increased.

#How Screening Works

When someone gets their eyes checked through the DESP, trained professionals look at the images to find any signs of diabetic retinopathy. If they find serious issues that could threaten someone's vision, the individual is referred to a hospital for further assessment and potential treatment.

With more and more patients needing these screenings and limited resources in a publicly funded Healthcare system, this process is becoming increasingly challenging for healthcare providers.

#Biennial vs. Annual Screening

Studies have shown that checking in every two years, instead of every year, may be safe and save money for those not at high risk. However, some evidence disagrees, stating that there isn't enough proof to recommend screenings beyond one year.

In 2016, the UK National Screening Committee (NSC) suggested moving to biennial screenings for those at low risk of losing their sight. This recommendation was based on a review of almost 350,000 patients across various regions in the UK, which showed that only a small percentage developed serious diabetic retinopathy over a two-year period.

However, some limitations were noted. The data mostly came from past records instead of planned trials, and there were concerns that people might not attend if screenings were spaced out more. Also, the differences among various racial and age groups weren't clearly detailed.

#The Impact of Ethnicity

In the UK, certain groups, like South Asian individuals, have a higher risk of diabetes and its complications compared to white people. This makes it important to look at how biennial screenings could affect different Ethnic groups and age ranges.

Despite the recommendation for biennial screenings, many people are still not taking advantage of this option. The concern is that extending the time between screenings might create gaps in healthcare for some groups, particularly those who are already disadvantaged.

#The Study

In an effort to address these issues, researchers looked at data from one of the most diverse screening programs in North-East London. They wanted to understand how quickly people without diabetic retinopathy developed serious issues and to see how different groups were affected.

The study involved individuals with diabetes who were screened between January 2012 and December 2021. A set number of people was identified for the study, following ethical guidelines.

#The Screening Process

During a screening visit, trained staff take the patient's history and check their vision. They then capture pictures of the back of the eye while the pupil is dilated. Up to three trained graders assess the images for any signs of diabetic retinopathy.

The grading system used classifies retinopathy from no retinopathy to severe cases requiring immediate attention. If the graders cannot assess an image, it is not included in the study.

#Data Collection

Researchers collected data from the screening program to understand who was getting screened and to analyze the results. They kept track of important information like age, gender, ethnicity, and type of diabetes to see how these factors affected the risk of developing serious retinopathy.

#Findings

From the data involving over 82,000 individuals, the researchers looked at the rates of developing serious diabetic retinopathy. They found that younger people and those from certain ethnic backgrounds were at higher risk than others.

Men generally had lower rates of serious conditions compared to women, and those with Type 1 diabetes had higher risks than those with Type 2. Importantly, the study found that people from black and South Asian backgrounds had much higher risks for serious retinopathy.

#The Impact of Biennial Screening

The researchers also explored what might happen if biennial screenings were put in place. They predicted that if this change occurred, a significant number of people would not have their serious conditions detected in time, leading to a delay in treatment.

Amongst those screened, a notable portion who developed serious diabetic retinopathy or proliferative diabetic retinopathy (which is a more severe type) would remain undiagnosed for an entire year if screenings were spaced out. These delays could lead to more severe and potentially irreversible vision loss.

#Importance of Timely Detection

The findings highlight that timely detection is crucial, especially for younger individuals who may face longer durations of diabetes if their condition isn't monitored closely. Delayed diagnoses could further widen the gap in health outcomes for certain groups, particularly in a diverse and economically challenged region.

#Addressing Healthcare Inequalities

The findings make it clear that simply following the NSC's recommendation for biennial screenings could worsen existing disparities in healthcare. Ethnic and age-related factors should be considered when determining screening intervals to avoid further inequalities in care.

#The Role of Technology

Using technology, like artificial intelligence (AI), could help maintain annual screening rates without overwhelming healthcare resources. In some places, AI has already been successfully used to assist in diabetic eye screening. Despite its promise, AI is not yet commonly used in the NHS screening program in England.

AI could potentially reduce the workload of human graders and maintain accuracy in identifying whether patients have diabetic retinopathy. If AI systems could help streamline the process, they may also play a role in ensuring that annual screenings could continue, especially for those at low risk.

#Conclusion

The research showed significant disparities in how different groups develop serious diabetic eye conditions. These disparities must be addressed to ensure equitable healthcare for everyone. While changing to biennial screenings may seem cost-effective, it could inadvertently increase the risk of vision loss for some groups.

To prevent these negative outcomes, healthcare providers could look into alternative solutions that would allow for continued care while addressing the needs of all patient demographics. More studies are needed to explore these solutions and to gather further data on how different groups are affected by diabetic retinopathy.

In summary, the findings call for careful consideration of how changes in screening protocols can impact different people, especially those who are already at risk. Ensuring that everyone gets the right care at the right time is crucial in the fight against diabetic retinopathy and its effects on vision.