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.

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.