International Conference on Ophthalmic Photography

Organized by
Australian Institute of Medical and Biological Illustration
Japanese Ophthalmic Photographers' Society
Ophthalmic Imaging Association
Ophthalmic Photographers' Society

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Sunday, 21 May 2006
Plenary Session 9
Diabetic Retinopathy Screening II
1.66 OPS Continuing Education Credits
10:50 Introduction By Moderator
Steve J Aldington
Imperial College Faculty of Medicine
London, England, UK
10:55 Retinal Screening In Northland New Zealand
Dianne Vickers
Northland Health
Whangarei, Northland, New Zealand
A video (DVD-MPEG2) of approximately seven minutes duration shows diabetic retinal screening in rural Northland New Zealand.
The video demonstrates a mobile Canon system being transported and used with appreciation of the terrin covered and the culture of New Zealand's indigenous Maori population. The DVD includes statistics of population, coverage and effectiveness of screening.

11:10 Remote Area Mobile Diabetic Retinopathy Screening
Chris J Barry
Lions Eye Institute
Perth, Western Australia, Australia
Purpose: Diabetic retinopathy screening has been available in Western Australia since 1979 in regional centres. More remote diabetic screening programmes have been initiated since the 1980s. Review of the results obtained are a necessary component for ongoing funding.
Method: Data retrieval and auditing is a major component of any screening programme, however, data is rarely easilly accessable particularly from remote area programmes. The Kimberley area of Western Australia is perhaps the most isolated part of our state and, arguably, the world.
Polaroid options for non mydriatic cameras are soon to be unavailable, we trialed a digital camera in the remote western desert region of Western Australia.
Results: Data showed that indigenous camera operators had a higher rate of low grade images. It was determined that mydriatic agents were not used extensively due to a communication breakdown. Once remedied, results showed that both medical workers and indigenous operators maintained similar quality performance levels.
Current digital non mydriatic cameras are not robust enough for extensive vibration over poor quality roads and modifications are necessary before a digital service can be implemented in remote communities.
Conclusion: Although the number of diabetics screened in remote areas are relatively small due to travel times and community sizes, our results show a continuing need for this service with results ranging from 20%-40% of those screened showing some ophthalmic pathology.

11:25 Screening For Diabetic Retinopathy In Patients With Diabetes Mellitus
Tamara Milenkaya, Yu.I. Suntsov, E.G. Bessmertnaya, V.K. Aleksandrova, L.L. Bolotskaya
National Endocrinology Research Center
Moscow, Russia
Diabetic retinopathy (DR) is a vascular complication of DM. Its early diagnosis and onset of therapy prevents the development of more serious conditions and the loss of vision.
Purpose: To study prevalence and development of DR in diabetic patients in 14 regions of Russia.
Materials and Methods: Field studies were carried out in 14 regions of Russia in the framework of the joint project of Endocrinological Research Centre and Novo Nordisk "Screening for diabetes complications and assessment of diabetes care quality", a component of the Federal Program "Diabetes mellitus". A total of 2985 patients with DM were examined including 1992 with type 2 DM.
Results: The total number of subjects with DM increased by 12-15% during a period of 1993-2003. The screening study revealed the presence of DR in 1226 patients (3.92% - children and adolescents, 47.2% - adults). Proliferative DR was documented in 35-40% of the patients with type 1 DM compared to 15-25% in patients with type 2 DM. The latter more frequently suffered non-proliferative DR and maculopathy (47-53%). A large (25-30%) fraction of patients with type 2 DM in certain regions of Siberia did not develop DR despite the duration of DM in excess of 30 years. In the present study, new cases of DR were diagnosed in 139 adults and 29 children and adolescents.
These newly diagnosed cases were treated by laser photocoagulation.
Conclusions: Screening of DM patients for DR ensured early diagnosis and timely treatment of this complication and thereby prevention of blindness.

11:40 DR Screening - A Synopsis Of Medical Imaging's UK Perspective And Experience
Shahjalal Ahmed, Jonathan Hildred
Medical Imaging UK Ltd
Enfield, Middlesex, UK
The aim of diabetic retinopathy screening is to detect all retinopathy and in particular, sight-threatening retinopathy. By doing so, retinopathy progression can be halted or reversed by either achieving better systemic management of diabetes or by treating with laser if appropriate. Digital retinal photography has been identified as being the optimal and most cost-effective method of performing retinopathy screening.
The UK National Screening Committee has identified the very obvious benefits of establishing a nationwide protocol for retinopathy screening and has set a National Standards Framework for its inception and subsequent operation.
With the establishment of guidelines, protocols and modalities of operation, quality assurance, audit capabilities and achievement targets the next step is the creation of a cohesive screening program from concept through to operation. This requires: a body to commission and monitor the service, a management team and personnel to carry out screening. It requires dedicated management software, a specific IT infrastructure and ophthalmology resources to manage referrals and treatment.
In the UK, retinal photography has classically been performed by imaging professionals in the hospital environment. The UK national screening guidelines recognise the need for a community based modality for retinopathy screening. It identifies the need for specific training that extends beyond retinal photography; that facilitates the development of the skills necessary to grade images and manage appropriately all patients within the screening program. A national qualification is currently in a pilot phase, for the creation of qualified, trained and accredited retinopathy screening personnel.
Our experience of the design, implementation and management of retinopathy screening programs throughout the UK is outlined, including our involvement in and the progress of the pilot phase of the diploma in diabetic retinopathy screening.
Diabetic retinopathy is the single most common cause of blindness in the adult working population in the UK. The necessity of diabetic retinopathy screening is uncontroversial. Early detection of all retinopathy including sight threatening retinopathy and appropriate management and treatment is of significant tangible benefit to diabetic patients and lessens the impact of diabetes on the patient, the NHS and on the wider community.

11:55 Diabetes Screening Programs At The Queen Elizabeth Hospital
Anton C Drew
The Queen Elizabeth Hospital
Woodville South, South Australia, Australia
At present there are two concurrent Diabetes Retinal Screening Programs being run in the Ophthalmology Unit, and this talk will give a brief overview on how they are conducted and present figures from last calendar year to give a snapshot of our diagnostic findings.
The first program is providing a service for the Diabetes/Endocrinology Unit at The Queen Elizabeth Hospital and involves one aspect of a “total care package” provided to patients referred to their service. Patients are admitted as a Day Only case and have a range of tests to ascertain their diabetes control, present status, receive diabetes education, and finish by having fundal photographs taken. These photographs are reported on by an Ophthalmologist and a report forwarded to the D/E Unit to be added to the rest of the test results which are then added to the D/E Unit database from which a form letter is sent to the patient’s General Practitioner.
Program 2, is an “in house” screening program run by the Ophthalmology Unit of our own patients, who are either referred by an Optometrist or General Practitioner specifically for diabetes assessment, or are picked up during routine Ophthalmic examinations for other conditions. After initial assessment these patients are referred back for photographic assessment until such time as pathology is discovered. Again, all images are reported on by an Ophthalmologist and a copy of the report is sent to both the patient and referring source.

12:10 Panel Discussion 2 On DR Screening

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Sunday, 21 May 2006 Plenary Session 9 Diabetic Retinopathy Screening II 1.66 OPS Continuing Education Credits
10:50	Introduction By Moderator Steve J Aldington Imperial College Faculty of Medicine London, England, UK
10:55	Retinal Screening In Northland New Zealand Dianne Vickers Northland Health Whangarei, Northland, New Zealand A video (DVD-MPEG2) of approximately seven minutes duration shows diabetic retinal screening in rural Northland New Zealand. The video demonstrates a mobile Canon system being transported and used with appreciation of the terrin covered and the culture of New Zealand's indigenous Maori population. The DVD includes statistics of population, coverage and effectiveness of screening.
11:10	Remote Area Mobile Diabetic Retinopathy Screening Chris J Barry Lions Eye Institute Perth, Western Australia, Australia Purpose: Diabetic retinopathy screening has been available in Western Australia since 1979 in regional centres. More remote diabetic screening programmes have been initiated since the 1980s. Review of the results obtained are a necessary component for ongoing funding. Method: Data retrieval and auditing is a major component of any screening programme, however, data is rarely easilly accessable particularly from remote area programmes. The Kimberley area of Western Australia is perhaps the most isolated part of our state and, arguably, the world. Polaroid options for non mydriatic cameras are soon to be unavailable, we trialed a digital camera in the remote western desert region of Western Australia. Results: Data showed that indigenous camera operators had a higher rate of low grade images. It was determined that mydriatic agents were not used extensively due to a communication breakdown. Once remedied, results showed that both medical workers and indigenous operators maintained similar quality performance levels. Current digital non mydriatic cameras are not robust enough for extensive vibration over poor quality roads and modifications are necessary before a digital service can be implemented in remote communities. Conclusion: Although the number of diabetics screened in remote areas are relatively small due to travel times and community sizes, our results show a continuing need for this service with results ranging from 20%-40% of those screened showing some ophthalmic pathology.
11:25	Screening For Diabetic Retinopathy In Patients With Diabetes Mellitus Tamara Milenkaya, Yu.I. Suntsov, E.G. Bessmertnaya, V.K. Aleksandrova, L.L. Bolotskaya National Endocrinology Research Center Moscow, Russia Diabetic retinopathy (DR) is a vascular complication of DM. Its early diagnosis and onset of therapy prevents the development of more serious conditions and the loss of vision. Purpose: To study prevalence and development of DR in diabetic patients in 14 regions of Russia. Materials and Methods: Field studies were carried out in 14 regions of Russia in the framework of the joint project of Endocrinological Research Centre and Novo Nordisk "Screening for diabetes complications and assessment of diabetes care quality", a component of the Federal Program "Diabetes mellitus". A total of 2985 patients with DM were examined including 1992 with type 2 DM. Results: The total number of subjects with DM increased by 12-15% during a period of 1993-2003. The screening study revealed the presence of DR in 1226 patients (3.92% - children and adolescents, 47.2% - adults). Proliferative DR was documented in 35-40% of the patients with type 1 DM compared to 15-25% in patients with type 2 DM. The latter more frequently suffered non-proliferative DR and maculopathy (47-53%). A large (25-30%) fraction of patients with type 2 DM in certain regions of Siberia did not develop DR despite the duration of DM in excess of 30 years. In the present study, new cases of DR were diagnosed in 139 adults and 29 children and adolescents. These newly diagnosed cases were treated by laser photocoagulation. Conclusions: Screening of DM patients for DR ensured early diagnosis and timely treatment of this complication and thereby prevention of blindness.
11:40	DR Screening - A Synopsis Of Medical Imaging's UK Perspective And Experience Shahjalal Ahmed, Jonathan Hildred Medical Imaging UK Ltd Enfield, Middlesex, UK The aim of diabetic retinopathy screening is to detect all retinopathy and in particular, sight-threatening retinopathy. By doing so, retinopathy progression can be halted or reversed by either achieving better systemic management of diabetes or by treating with laser if appropriate. Digital retinal photography has been identified as being the optimal and most cost-effective method of performing retinopathy screening. The UK National Screening Committee has identified the very obvious benefits of establishing a nationwide protocol for retinopathy screening and has set a National Standards Framework for its inception and subsequent operation. With the establishment of guidelines, protocols and modalities of operation, quality assurance, audit capabilities and achievement targets the next step is the creation of a cohesive screening program from concept through to operation. This requires: a body to commission and monitor the service, a management team and personnel to carry out screening. It requires dedicated management software, a specific IT infrastructure and ophthalmology resources to manage referrals and treatment. In the UK, retinal photography has classically been performed by imaging professionals in the hospital environment. The UK national screening guidelines recognise the need for a community based modality for retinopathy screening. It identifies the need for specific training that extends beyond retinal photography; that facilitates the development of the skills necessary to grade images and manage appropriately all patients within the screening program. A national qualification is currently in a pilot phase, for the creation of qualified, trained and accredited retinopathy screening personnel. Our experience of the design, implementation and management of retinopathy screening programs throughout the UK is outlined, including our involvement in and the progress of the pilot phase of the diploma in diabetic retinopathy screening. Diabetic retinopathy is the single most common cause of blindness in the adult working population in the UK. The necessity of diabetic retinopathy screening is uncontroversial. Early detection of all retinopathy including sight threatening retinopathy and appropriate management and treatment is of significant tangible benefit to diabetic patients and lessens the impact of diabetes on the patient, the NHS and on the wider community.
11:55	Diabetes Screening Programs At The Queen Elizabeth Hospital Anton C Drew The Queen Elizabeth Hospital Woodville South, South Australia, Australia At present there are two concurrent Diabetes Retinal Screening Programs being run in the Ophthalmology Unit, and this talk will give a brief overview on how they are conducted and present figures from last calendar year to give a snapshot of our diagnostic findings. The first program is providing a service for the Diabetes/Endocrinology Unit at The Queen Elizabeth Hospital and involves one aspect of a “total care package” provided to patients referred to their service. Patients are admitted as a Day Only case and have a range of tests to ascertain their diabetes control, present status, receive diabetes education, and finish by having fundal photographs taken. These photographs are reported on by an Ophthalmologist and a report forwarded to the D/E Unit to be added to the rest of the test results which are then added to the D/E Unit database from which a form letter is sent to the patient’s General Practitioner. Program 2, is an “in house” screening program run by the Ophthalmology Unit of our own patients, who are either referred by an Optometrist or General Practitioner specifically for diabetes assessment, or are picked up during routine Ophthalmic examinations for other conditions. After initial assessment these patients are referred back for photographic assessment until such time as pathology is discovered. Again, all images are reported on by an Ophthalmologist and a copy of the report is sent to both the patient and referring source.
12:10	Panel Discussion 2 On DR Screening