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A new health care pathway could be safe to implement in clinical practice.
Type 1 and 2 diabetes patients would save money using a new grading system to detect diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) compared to the current standard care, according to a paper published in Ophthalmology.
Investigators from the UK conducted a prospective study across 13 hospitals in order to test the diagnostic accuracy, acceptability and costs of a new health care pathway for people previously treated for DME and PDR. The participants were adults with type 1 or type 2 diabetes who had either inactive or active disease at the time of enrollment. The participants also had previously successful treatment for DME and PDR.
The investigators’ new model for health care combined multimodal imaging and ultra-wide-field fundus images that were interpreted by trained ophthalmic graders to detect disease progression, they explained. This method was compared to the current standard care, involving ophthalmologists conducting face-to-face examinations. However, they also wrote, standard care faces problems including the fact that delays that result from waiting for appointments with ophthalmologists can lead to sight loss.
“Strategies to increase capacity of medical retina clinics are urgently needed,” the study authors wrote.
The investigators said of the 397 patients in their study that 272 had DME and 281 had PDR. About 40% of the patients presented with severe disease in the DME group and about 20% presented with severe disease in the PDR group.
In their analysis, the researchers found that ophthalmic graders had a sensitivity 97% and specificity of 31% compared to the standard care to detect DME, they said. There were similar results observed when evaluating people with DME that required further treatment, with central-involving DME, when only referral for active DME was considered, and when patients were evaluated in NHS compared to research clinics, the study authors added.
In detecting PDR, the investigators found that ophthalmic graders had lower sensitivity. Diagnostic accuracy results were similar to those of the main analysis when grading patients that required further treatment, the study authors said. The findings were similar whether patients were assessed in NHS or at research clinics, the investigators found. Additionally, sensitivity and specificity were lower when considering only referrals for active PDR, they said.
The researchers reported that there were no adverse events experienced by patients in either pathway.
In evaluating cost, the investigators determined that the DME cost-difference savings for the graders’ pathway would be £1390 ($1829.29) per 100 follow up visits and £461 ($606.69) for 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) images and £1889 ($2485.99) for ultra-wide field images per 100 follow-up visits.
These findings indicate that the new health care pathway would be safe to implement in clinical practice, the study authors wrote.
“The new ophthalmic grader pathway, if implemented appropriately, would help health services to increase capacity, reduce waiting times for patients to be seen in clinics and subsequently, save sight,” the study authors concluded, noting that artificial intelligence and virtual clinics could also be in the future of health care. “The pathway, for example, could be implemented as a ‘one-stop’ clinic, with images and image review being done at the same session and ophthalmic graders providing the results to patients immediately.”