Feasibility of screening for diabetic retinopathy at an Australian pathology collection service: a pilot study.

OBJECTIVE: To evaluate the feasibility of a novel diabetic retinopathy (DR) screening model using a pathology collection centre (PCC) as a screening site. DESIGN AND SETTING: Cross-sectional pilot study conducted in one urban PCC in Victoria between 1 September 2009 and 15 March 2010. Trained pathology staff screened participants for DR using undilated, non-stereoscopic colour fundus photography. PARTICIPANTS: Participants were patients who spoke English, were aged at least 12 years, had type 1 or type 2 diabetes, and did not undertake biannual DR screening. MAIN OUTCOME MEASURES: Proportion of patients who do not participate in biannual DR screening; proportion of patients who accept DR screening while attending a PCC; proportion of gradable images; patient acceptance of the screening model; and effectiveness of the follow-up pathway. RESULTS: Over 6 months, 289 English-speaking patients with diabetes attended the PCC, of whom 99 (34.3%) had not undertaken biannual DR screening. Of these, 93 (93.9%) accepted our screening service. Overall, retinal images were sufficient for interpretation in 88 patients (94.6%) and the median time for photography was 6 minutes (interquartile range, 10 minutes). Two, eight and six cases of minimal, mild and moderate non-proliferative DR (NPDR) in the worst eye were found, respectively. Dissemination of screening results to treating doctors and patients was found to be suboptimal and will need to be revised. CONCLUSION: DR screening in one urban PCC appears to be a feasible alternative for diabetic patients who do not undertake biannual screening for DR.

Methodology and early findings of the Diabetes Management Project: a cohort study investigating the barriers to optimal diabetes care in diabetic patients with and without diabetic retinopathy.

BACKGROUND: The Diabetes Management Project is investigating the clinical, behavioural and psychosocial barriers to optimal diabetes care in individuals with and without diabetic retinopathy. DESIGN: Prospective cohort. PARTICIPANTS: Two hundred and twenty-three and 374 patients without and with diabetic retinopathy, respectively. METHODS: All individuals underwent a comprehensive dilated eye test, anthropometric measurements, blood and urine samples, and psychosocial questionnaires. MAIN OUTCOME MEASURES: Good glycaemic control was defined as glycosylated haemoglobin < 7%, good blood pressure control as systolic and diastolic values ≤130 and 80 mmHg, respectively, and good diabetes control as glycosylated haemoglobin < 7% and blood pressure values ≤130 and 80 mmHg. RESULTS: Four hundred and one males (65.4%) and 212 females (34.6%) aged 26-90 years (mean age ± standard deviation = 64.6 ± 11.6) were examined. The median glycosylated haemoglobin for all participants was 7.5% (interquartile range = 1.7%). Average systolic and diastolic blood pressure values were 139.7 mmHg (standard deviation = 18.8) and 92.7 mmHg (standard deviation = 30.9), respectively. Initial data analyses indicate that over two-thirds of participants with diabetes have poor glycaemic control, which was worse in those with diabetic retinopathy compared with those without (76.3% vs. 49.3%; P < 0.001). Blood pressure control was similar for those with and without diabetic retinopathy, with almost a third (28.5%) of the total sample having poor blood pressure control. Overall, those with diabetic retinopathy had poorer diabetes control than those without (24.3% vs. 13.7%; P = 0.002). CONCLUSIONS: Our findings substantiate the implementation of the Diabetes Management Project, developed to assess factors associated with suboptimal diabetes care.

Impact of a low-vision self-management program on informal caregivers.

PURPOSE: To evaluate caregivers' experiences and outcomes following attendance at a patient-centered group-based self-management program called "Living with Low Vision." METHODS: Participants were caregivers of adults with low vision. A pre-post study design evaluated the impact of the program on single-item indicators that assessed levels of understanding of low vision, awareness of devices, aids and practical strategies, and questionnaires to assess confidence to deal with low vision, self-efficacy, and emotional well being. Participants formed three groups: (1) those who attended the program [intervention group 1 (IG1)] and received a take-home pack; (2) those who received a take-home pack only [intervention group 2 (IG2)]; and (3) those who received no intervention [comparison group (CG)]. RESULTS: Sixty participants (IG1 = 16, IG2 = 33, CG = 11) with mean (SD) age 67.2 years (SD = 14.8) were recruited. Half (n = 31; 51.7%) were the spouse of the adults with low vision. With the exception of two single-item indicators that assessed awareness of low-vision aids and practical strategies; no significant group differences on follow-up scores between the three study groups were found on any measure. Compared with CG participants, IG1 and IG2 participants demonstrated significantly greater awareness of low-vision aids and practical strategies (p < 0.05, for all). In addition, IG1 participants demonstrated significantly improved awareness of practical strategies than IG2 participants (p = 0.024). Most IG1 participants (n = 10; 62.5%) agreed that the program was relevant and helpful, and most would recommend it to other caregivers. CONCLUSIONS: Involving caregivers in a patient-centered group-based self-management program and providing them with an informative take-home self-help pack improved their awareness of low-vision aids, devices, and practical strategies. Our findings should be followed up with larger studies to clearly identify optimal ways of providing caregivers with information and problem-solving skills to effectively manage the demands of low vision.

A self-management program for low vision: program overview and pilot evaluation.

PURPOSE: This article describes a new low vision-specific self-management (SM) program for older adults with vision impairment, and provides preliminary data on program evaluation from two small pilot groups. METHOD: The SM program was an 8-week, structured group program aiming to enhance participants' skills to manage the practical and emotional consequences of vision impairment. The pilot evaluation was a single group post-test design. Participants took part in a structured interview to obtain their views on the content, format and delivery of the program. RESULTS: The program was perceived as useful and the duration and level of information provided were deemed appropriate. Participants reported the program to have a positive impact on their mood, understanding of low vision and services available and their ability to manage the challenges of low vision. CONCLUSIONS: The content and delivery of the program is appropriate for older individuals with vision impairment. Further work is required to provide a methodologically sound evaluation of this program and contribute to the evidence-base regarding the effectiveness of approaches to vision rehabilitation.

A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services.

OBJECTIVE: To investigate the effectiveness of a low vision self-management programme (LVSMP) in older adults. METHODS: Participants (n=153) were existing clients of a national low vision rehabilitation organisation randomly allocated to usual services (n=60) or usual services plus LVSMP (n=93). The LVSMP was an 8-week group programme facilitated by low vision counsellors. The primary outcome was vision-specific quality of life (QoL) measured using the Impact of Vision Impairment (IVI) questionnaire. Secondary outcomes emotional well-being, self-efficacy and adaptation to vision loss were measured using the depression, anxiety, stress scale (DASS), general self-efficacy scale (GSES), and short form adaptation to age-related vision loss scale (AVL12). RESULTS: At one and six month follow-up assessments, no significant between-group differences were found for vision-specific QoL, emotional well-being, adaptation to vision loss or self-efficacy (p>0.05). Univariate and multivariate analyses revealed no impact of the intervention on outcome measures. CONCLUSIONS: In contrast to previous work, our study found limited benefit of a LVSM programme on QoL for older adults accessing low vision services. PRACTICE IMPLICATIONS: When implementing self-management programmes in low vision rehabilitation settings, issues of client interest, divergence of need, programme accessibility and fidelity of intervention delivery need to be addressed.

In-home monitoring of older adults with vision impairment: exploring patients', caregivers' and professionals' views.

OBJECTIVE: To develop a conceptual framework for the design of an in-home monitoring system (IMS) based on the requirements of older adults with vision impairment (VI), informal caregivers and eye-care rehabilitation professionals. MATERIALS AND METHODS: Concept mapping, a mixed-methods statistical research tool, was used in the construction of the framework. Overall, 40 participants brainstormed or sorted and rated 83 statements concerning an IMS for older adults with VI. Multidimensional scaling and hierarchical cluster analysis were employed to construct the framework. A questionnaire yielded further insights into the views of a wider sample of older adults with VI (n=78) and caregivers (n=25) regarding IMS. RESULTS: Concept mapping revealed a nine-cluster model of IMS-related aspects including affordability, awareness of system capabilities, simplicity of installation, operation and maintenance, system integrity and reliability, fall detection and safe movement, user customization, user preferences regarding information delivery, and safety alerts for patients and caregivers. From the questionnaire, independence, safety and fall detection were the most commonly reported reasons for older adults and caregivers to accept an IMS. Concerns included cost, privacy, security of the information obtained through monitoring, system accuracy, and ease of use. DISCUSSION: Older adults with VI, caregivers and professionals are receptive to in-home monitoring, mainly for fall detection and safety monitoring, but have concerns that must be addressed when developing an IMS. CONCLUSION: Our study provides a novel conceptual framework for the design of an IMS that will be maximally acceptable and beneficial to our ageing and vision-impaired population.