Marianne Aamodt; Vibeke Sundling

doi:10.5384/sjovs.vol10i1p18-22

Authors

Marianne Aamodt National Centre for Optics, Vision and Eye Care Department of optometry, radiography and lighting design Faculty of Health and Social Sciences University College of Southeast Norway
Vibeke Sundling National Centre for Optics, Vision and Eye Care Department of optometry, radiography and lighting design Faculty of Health and Social Sciences University College of Southeast Norway

DOI:

https://doi.org/10.5384/sjovs.vol10i1p18-22

Keywords:

Diabetic retinopathy, screening, optometrists, training

Abstract

Diabetic retinopathy is a sight threatening complication of diabetes mellitus. Regular eye examinations by trained health professionals can help prevent this. Although ophthalmologists have screening responsibility in Norway today, Norwegian optometrists regularly examine the ocular health of a large part of the population. The exact number of people with diabetes in Norway is unknown, and many are likely undiagnosed. Optometrists should be able to detect and grade diabetic retinopathy and ensure proper management of these patients. Previous studies in Norway have shown that optometrists need improved diagnostic skills to provide screening according to recommended standards. This study investigated the effect of web-based targeted training on the optometrists’ ability to detect, classify and manage patients with diabetic retinopathy. The study had an experimental prospective design. Eighteen optometrists working in optometric practice in Norway participated in a web-based survey "Visual Identification and Management of Ocular Conditions" (VIMOC) related to diabetic retinopathy before and after a minimal web-based training protocol. In the VIMOC, the optometrists assessed 14 retinal digital photographs of people with known diabetes. An ophthalmologist’s assessment and grading of the images was considered as the gold standard. The prevalence of retinopathy in the sample was set to 50% to prevent false high specificity. The web-based training significantly improved the optometrists’ diagnostic sensitivity, but did not significantly improve specificity. The diagnostic sensitivity before training was 71.4% (SD = 19.6). After training, the sensitivity was 85.71% (SD = 12.9). However, only six (33%) of the optometrists achieved the recommended screening standard; sensitivity of 80% or better and specificity of 95% of better. Web-based training in screening for diabetic retinopathy significantly improved optometrists’ screening and grading skills. Specific training in diabetes and screening for diabetic retinopathy are of great importance for detection and management of patients with diabetes by optometrists.

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Author Biography

Vibeke Sundling, National Centre for Optics, Vision and Eye Care Department of optometry, radiography and lighting design Faculty of Health and Social Sciences University College of Southeast Norway

PhD, Associate Professor

References

Porta, M. and F. Bandello, Diabetic retinopathy A clinical update. Diabetologia, 2002. 45(12): p. 1617-34.

Bamashmus, M.A., B. Matlhaga, and G.N. Dutton, Causes of blindness and visual impairment in the West of Scotland. Eye (Lond), 2004. 18(3): p. 257-61.

Bek, T., Øjenkomplikationer ved type 2-diabetes (Ophthalmic complications in patients with diabetes type 2). Ugeskr Læger 2012, 2012. 174: p. 2147.

Backlund, L.B., P.V. Algvere, and U. Rosenqvist, New blindness in diabetes reduced by more than one-third in Stockholm County. Diabetic Medicine, 1997. 14(9): p. 732-40.

Kristinsson, J.K., et al., Active prevention in diabetic eye disease. A 4-year follow-up. Acta Ophthalmologica Scandinavica, 1997. 75(3): p. 249-54.

Stefansson, E., et al., Screening and prevention of diabetic blindness. Acta Ophthalmologica Scandinavica, 2000. 78(4): p. 374-85.

Zoega, G.M., et al., Screening compliance and visual outcome in diabetes. Acta Ophthalmologica Scandinavica, 2005. 83(6): p. 687-90.

Delcourt, C., P. Massin, and M. Rosilio, Epidemiology of diabetic retinopathy: expected vs reported prevalence of cases in the French population. Diabetes Metab, 2009. 35(6): p. 431-8.

Diabetesforbundet Fakta om diabetes (Facts about diabetes). 2014.

Norsk Oftalmologisk Forening, KONUS-rapporten: Kartlegging og oftalmologisk nasjonal utredning

av framtidig status (Mapping and ophthalmological national assessment of future status). 2012.

Bertelsen, G., et al., Tromso eye study: prevalence and risk factors of diabetic retinopathy. Acta Ophthalmol, 2013. 91(8): p. 716-21.

Cooper, J.G., et al., Behandlingen av type 1-diabetes i spesialisthelsetjenesten – data fra Norsk diabetesregister for voksne (Treatment of type 1 diabetes in the specialist health service - data from the Norwegian Diabetes Register for Adults). Tidsskrift for Den Norske Legeforening, 2013. 133(21): p. 2257-62.

Hapnes, R. and H. Bergrem, Diabetic eye complications in a medium sized municipality in southwest Norway. Acta Ophthalmol Scand, 1996. 74(5): p. 497-500.

Kilstad, H.N., et al., Prevalence of diabetic retinopathy in Norway: report from a screening study. Acta Ophthalmol, 2012. 90(7): p. 609-12.

Sundling, V., et al., Suspected retinopathies in Norwegian optometric practice with emphasis on patients with diabetes: a cross-sectional study. BMC Health Serv Res, 2008. 8: p. 38.

Sundling, V., et al., Retinopathy and visual impairment in diabetes, impaired glucose tolerance and normal glucose tolerance: the Nord-Trondelag Health Study (the HUNT study). Acta Ophthalmol, 2012. 90(3): p. 237-43.

Gibbins, R.L., et al., Practical application of the European Field Guide in screening for diabetic retinopathy by using ophthalmoscopy and 35 mm retinal slides. Diabetologia, 1998. 41(1): p. 59-64.

Harvey, J.N., et al., Towards comprehensive population-based screening for diabetic retinopathy: operation of the North Wales diabetic retinopathy screening programme using a central patient register and various screening methods. J Med Screen, 2006. 13(2): p. 87-92.

Hulme, S.A., et al., Evaluation of a district-wide screening programme for diabetic retinopathy utilizing trained optometrists using slit-lamp and Volk lenses. Diabet Med, 2002. 19(9): p. 741-5.

Prasad, S., et al., Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy. Eye (Lond), 2001. 15(Pt 5): p. 595-601.

Schmid, K., et al., The detection of diabetic retinopathy by Australian optometrists. Clinical and experimental optometry, 2002. 85(4): p. 221-228.

Sundling, V., P. Gulbrandsen, and J. Straand, Sensitivity and specificity of Norwegian optometrists' evaluation of diabetic retinopathy in single-field retinal images - a cross-sectional experimental study. BMC Health Serv Res, 2013. 13: p. 17.

Sundling, V. Diabetes retinopati (Diabetes retinopathy). 2013.

Sundling, V. Diabetes, syn og øyehelse (Diabetes, vision and eye care). 2012.

Aakre, B. and E. Svarverud, Utdanning for klinisk kompetanse (Education for clinical competence). Optikeren 2011, 2011. 5;: p. 52-53.

British Diabetic Association, Retinal photographic screening for diabetic eye disease. A British Diabetic Association Report. 1997, British Diabetic Association: London.

Norges Optikerforbund Retningslinjer i Klinisk Optometri (Clinical guidelines in Optometry). 2010.

Murgatroyd, H., et al., Effect of mydriasis and different field strategies on digital image screening of diabetic eye disease. Br J Ophthalmol, 2004. 88(7): p. 920-4.

Scanlon, P.H., et al., The influence of age, duration of diabetes, cataract, and pupil size on image quality in digital photographic retinal screening. Diabetes Care, 2005. 28(10): p. 2448-53.

Wilson, J.M.G. and G. Jungner, Principles and practice of screening for disease. 1968, Genève: World Health Organization.

Schmid, K.L., et al., The detection of diabetic retinopathy by Australian optometrists. Clin Exp Optom, 2002. 85(4): p. 221-8.

Olson, J.A., et al., A comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathy. Diabet Med, 2003. 20(7): p. 528-34.

Sundling, V., et al., Optometric practice in Norway: a cross-sectional nationwide study. Acta Ophthalmol Scand, 2007. 85(6): p. 671-6.

Javitt, J.C. and L.P. Aiello, Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med, 1996. 124(1 Pt 2): p. 164-9.

Burnett, S., et al., The implementation of prompted retinal screening for diabetic eye disease by accredited optometrists in an inner-city district of North London: a quality of care study. Diabet Med, 1998. 15 Suppl 3: p. S38-43.

McCarty, C.A., et al., Diabetic retinopathy: effects of national guidelines on the referral, examination and treatment practices of ophthalmologists and optometrists. Clin Experiment Ophthalmol, 2001. 29(2): p. 52-8.