Original Title: Incidencia de retinopatía diabética a partir de un programa de despistaje en cámara no midriática empleado en pacientes diabéticos de la Comunidad Autónoma del País Vasco (CAPV)

Authors' objectives: The main aim of this study is to calculate the most appropriate frequency for retinopathy screening in diabetic patients in our environment, based on the observed incidence of retinopathy in patients included within the existing screening programme in the Autonomous Community of the Basque Country, which examines retinographs obtained with a 45 degree non mydriatic camera.

Authors' results and conclusions: 86% of patients free of retinopathy in the basal exploration, remained free of retinopathy at the end of two years. When the incidence with regard to the development of high risk retinopathy was examined, it was observed that, with the exception of Type II patients, more than 95% of the patients remained free of high risk retinopathy at the end of the fourth year, irrespective of the development time and degree of metabolic control of their diabetes. 94% of patients with mild Non Proliferative Retinopathy remained free of high risk retinopathy at the end of two years. The main limitation of this study derives from the detection of retinopathy based on a method with a sensitivity and specificity of under 100% (45 degree non mydriatic retina camera), and therefore a certain level of deviation with regard to the true incidence is expected.

Authors' recommendations: CONCLUSIONS AND RECOMMENDATIONS 1. By stratifying the sample examined according to the type of Diabetes Mellitus, the results show a significantly lower survival rate in Type II patients at all levels. Type II diabetic patients are confirmed as the main objective for screening in our environment. 2. The advisable frequency for screening high risk retinopathy using the 45 degree non mydriatic retina camera in diabetic patients without retinopathy is four years for patients with Type I diabetes and three years for patients with Type II diabetes. 3. The recommended frequency for screening high risk retinopathy using the 45 degree non mydriatic retina camera in diabetic patients with mild Non Proliferative Diabetic Retinopathy is two years.

Authors' methods: — Bibliographical search: Medline- Current Contents (January 1976 to December 2003) and Cochrane Library, limited to the English and Spanish languages at least in the abstract. — Retrospective Monitoring Observational Epidemiological Survey from December 1998 to December 31 2003, based on the records of diabetic patients with information available on their retinopathy at the time they were added to the record and on at least one subsequent visit, according to the ophthalmologic diagnosis of the presence-degree of their retinopathy based on Polaroid® photographs obtained with a 45° non mydriatic retina camera. This camera makes use of the physiological dilatation of the pupil in darkness, allowing the camera to be focused and visualised by means of infrared illumination. The operator controls the camera by means of a 9-inch TV monitor, which shows simultaneously the viewable image and the focusing system. — Information from 490 selected diabetic patients was gathered by interns specially contracted for this purpose and the ophthalmologic assessment was made in each case by the same ophthalmologist specialised in the retina. — Special techniques were applied to measure the survival function in order to take into consideration the die erent monitoring periods of each patient after the first funduscopic exploration. The effect of different variables on the survival function was estimated by means of the «log-rank» test. P values of under 0.05 were considered statistically significant.

Project Status: Completed

Year Published: 2006

URL for published report: https://www.euskadi.eus/contenidos/informacion/2006_osteba_publicacion/es_def/adjuntos/2006/d_06-03_retinopatia.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>