![]() Such a model combines multiple prognostic factors to predict which patients are at higher risk of progression to visual loss and thus need closer observation or treatment to prevent loss of vision. A similar approach will also help optimise hospital eye services. There have been successful attempts at optimising diabetic screening services through stratification of patients by risk of progression of DR using a prognostic prediction model. Prognostic modelling/nomograms can aid decision-making. Various modifications to improve the service have been proposed, like digital surveillance using optical coherence tomography (OCT), and virtual clinics within DESP. In the United Kingdom, ~50% of referrals with STR do not need intervention and are observed in the hospital eye service for a variable period of time, placing extra burden on these services. In the United States, yearly screening is recommended to all type 2 diabetes mellitus (T2DM) patients at diagnosis and afterwards, type 1 diabetes mellitus (T1DM) patients are recommended to have screening on an annual basis, commencing 5 years after diagnosis. ![]() When the disease progresses to sight-threatening diabetic retinopathy (STR) stage-(R2, R3 or M1), they are referred to the hospital eye services for closer observation and treatment (Fig. 1 and Table A1) they are retained within the DESP and reviewed yearly. If the screening findings indicate low risk (retinopathy stage R0, R1 and M0, see Fig. Screening uptake in the year 2015/16 was 82.5%. DESP provides annual diabetic retinopathy screening to all patients with diabetes above 12 years of age. In the United Kingdom, diabetic retinopathy (DR) services are organised into diabetic eye screening programmes (DESP) and hospital eye services. ![]() While services may be organised differently from country to country, the care pathways are likely to be similar with patients at higher risk being provided closer monitoring and care. The detection of retinopathy has also increased through better population screening. There has been a global increase in the number of people with diabetes, rising from 108 million in 1980 to 422 million in 2014. However, these models will also need updating and external validation in multiple hospital settings before being implemented into clinical practice. Most models focussed on lower-risk patients, the majority had high risk of bias and doubtful applicability, but three models had some applicability for higher-risk patients. Participants, outcomes, predictors handling and modelling methods varied. Studies ranged from low to high risk of bias, mostly due to the need for external validation or missing data. Discriminative ability with c-statistics ranged from 0.57 to 0.91. Eleven models had internal validation, eight had external validation and one had neither. Twenty-two articles reporting on 14 prognostic models (including four updates) met the selection criteria. They were assessed for quality using criteria specified by PROBAST and CHARMS checklists, independently by two reviewers. Included studies had data extracted on model characteristics, predictive ability and validation. Search results were screened for relevance to the review question. ![]() We searched MEDLINE, EMBASE, COCHRANE CENTRAL, conference abstracts and reference lists of included publications for studies of any design using search terms related to diabetes, diabetic retinopathy and prognostic models. We wanted to look into the predictive ability and applicability of the existing models for the higher-risk patients referred into hospitals. ![]() Prognostic prediction models have been used to optimise services but these were intended for early detection of sight-threatening retinopathy and are mostly used in diabetic retinopathy screening services. With the increasing incidence of diabetic retinopathy and its improved detection, there is increased demand for diabetic retinopathy treatment services. ![]()
0 Comments
Leave a Reply. |