Individualised variable-interval risk-based screening for sight-threatening diabetic retinopathy: the Liverpool Risk...

Area of Science:

• Ophthalmology
• Diabetology
• Public Health

Background:

• Diabetic retinopathy screening is crucial for preventing vision loss in diabetes patients.
• Current screening protocols may not be optimally targeted or cost-effective.
• Individualized risk-based screening offers potential for improved resource allocation.

Purpose of the Study:

• To develop a generalizable risk calculation engine (RCE) for personalized diabetic retinopathy screening intervals.
• To assess the performance of the RCE compared to current screening practices.
• To explore the potential impact of RCE-based screening on cost-effectiveness and targeting.

Main Methods:

• Combined 5 years of photographic screening and primary care data for individuals with diabetes.
• Utilized Markov modeling to predict progression to referable diabetic retinopathy.
• Selected covariates including disease duration, HbA1c, age, systolic BP, and total cholesterol.
• Established screening intervals (6, 12, 24 months) and a risk threshold (2.5%) with patient and professional input.

Main Results:

• The RCE demonstrated strong predictive performance with corrected AUCs ranging from 0.88 to 0.91.
• Sensitivities/specificities for a 2.5% risk threshold varied by interval: 6 months (0.61/0.93), 12 months (0.67/0.90), 24 months (0.82/0.81).
• Implementing RCE-based intervals could reduce screen-positive events before scheduled dates by over 50% and decrease overall episodes by 30%.

Conclusions:

• The Liverpool RCE shows promising performance for local implementation in diabetic retinopathy screening.
• This individualized approach enhances local applicability, targeting, and cost-effectiveness.
• External validation is recommended before wider adoption of the RCE for diabetic retinopathy screening.