Details of HTA project in progress
Last updated: 31 August 2010 - Next update due: 7 September 2010
Research type: |
Primary Research (e.g. trial) |
Project title: |
Improving the value of screening for diabetic macular oedema using surrogate photographic markers |
Project ref: |
06/402/49 |
Cost: |
£536,537 |
Chief Investigator : |
Dr John A Olson, Consultant Ophthalmic Physician, Diabetes Retinal Screening Service, NHS Grampian |
Project Website |
http://www.abdn.ac.uk/ismo/ |
Start Date: |
May 2008 |
Estimated date of publication in HTA journal series: |
Mid 2012. This date takes account of time for report preparation and printing based on current average times for these activities. |
Plain English Summary |
The macula is the central part of the retina that gives us our central vision enabling us, for example, to read and to recognise people. Oedema is the term for accumulated fluid which, in diabetic eye disease, results from leaking blood vessels. In the United Kingdom it is the most common cause of visual loss in working age people. Screening programmes are intended to reduce sight loss from this condition by detecting it early. However, oedema is transparent and cannot be seen directly on a retinal photograph. Guidelines based on other features seen on photographs have therefore been devised. Unfortunately the existing guidelines result in many people having to attend hospital unnecessarily, creating anxiety and reducing the time available for those who actually have oedema. Optical coherence tomography is the best method doctors have for seeing this fluid. Although a rapid and safe test, it is expensive compared with normal photography. Our aims are (1) to determine how effective existing photographic referral criteria are compared with optical coherence tomography, and (2) to see whether computer analysis of photographic features improves the effectiveness of photography. The investigators have considerable expertise in screening for diabetic retinopathy. The principal investigator was the inaugural lead clinician for the screening programme in Scotland. Aberdeen University Biomedical Physics were recognised for their innovative and work in medical imaging technology by the award of the Queens Anniversary Prize 2001 and have developed software for automated detection of diabetic retinopathy shown to reduce the manual grading workload by 60%. The Health Economics Research Unit has an international reputation, receiving core funding from the Scottish Chief Scientist Office and NICE. The European Commission, amongst others, funds the Medical Statistics Team. The other investigators include Cheltenham (Lead clinician for England), Liverpool (where much of the existing literature emanates), Edinburgh (which piloted the national screening software for Scotland) and Southampton, which has acknowledged expertise in optical coherence tomography. Funding is requested for a scientist to develop the computer software. Staff to take images and analyse data are requested for the 5 collaborating centres. In addition an OCT scanner needs to be bought for Aberdeen as well as 2 PCs for data analysis. |
Project Abstract: |
Diabetes is a major problem for the National Health Service. In 2004 its prevalence was estimated to be 3.2%, however this is expected to double in the next ten to fifteen years. Diabetic retinopathy affects one in three of every person diagnosed with diabetes. Experience in the UK would suggest that at least 4% of those screened are subsequently referred to ophthalmology. The main indication for referral is to confirm or refute the presence of macular oedema. The macula is the central part of the retina that gives us our central vision enabling us, for example, to read and to recognise people. Oedema is the term for accumulated fluid which, in diabetic eye disease, results from leaking blood vessels. In the United Kingdom it is the most common cause of visual loss in working age people. Screening programmes are intended to reduce sight loss from this condition by detecting it early. However, oedema is transparent and cannot be seen directly on a retinal photograph. Guidelines based on other features seen on photographs have therefore been devised. Unfortunately the existing guidelines result in many people having to attend hospital unnecessarily, creating anxiety and reducing the time available for those who actually have oedema. Optical coherence tomography is the best method doctors have for seeing this fluid. Although a rapid and safe test, it is expensive compared with normal photography. Our aims are (1) to determine how effective existing photographic referral criteria are compared with optical coherence tomography, and (2) to see whether computer analysis of photographic features improves the effectiveness of photography. |
Project Protocol: |
Project protocol (pdf format, 5723 kbytes) |
URL of this page: |
http://www.hta.ac.uk/1703 |
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