Research
HEDRSCE is a hive of activity at the moment with everyone taking on research projects to make the most of our experience in screening and grading. Below are some of our research projects:
Helen Wharton and the HEDRSCE retinopathy screeners are involved in a new study which aims to improve the specificity of the current referral criteria for macular oedema. Seven different NHS trusts from across the UK are collaborating including NHS Grampian, Heart of England NHS trust, NHS Tayside, NHS Lothian, royal Liverpool & Broadgreen University Hospitals Trust, Norfolk & Norwich University Hospitals NHS Trust, Oxford Radcliffe Hospitals NHS Trust with the University of Aberdeen leading the study.
The purpose of the study is to determine the best method for detecting sight-threatening macular oedema using photographic surrogate markers for people with diabetes in the context of national screening programmes. Macular oedema is the build up of fluid within the macula region which causes the retina to thicken. Accumulation of excess fluid defocuses the image on the retina reducing visual acuity.
Retinal thickening is not clearly visible on the digital photographs used by screening programmes so a range of photographic surrogate markers (circinate within two disc diameters, exudates within 1 disc diameter, haemorrhages or microaneurysms within one disc diameter with VA <6/9) are used as referral criteria for macular oedema. However evidence from many screening programmes suggest that only around 10% of patients with these surrogate markers that are referred to an ophthalmologist have clinically significant macular oedema (CSMO). This shows that there is low specificity of the current referral criteria which means an increased burden of patients on ophthalmology departments and unnecessary anxiety for patients.
A total of 4000 patients with photographic surrogate markers of macular oedema (exudates within two disc diameters, haemorrhages or microaneurysms within one disc diameter) shall be recruited from the seven study centres. Each patient that meets the inclusion criteria will have photography and OCT on both eyes where possible. All images will be sent to Aberdeen University where they are analysed. The photographs will be assessed by a reference grader for the presence of photographic surrogate markers and then annotated using computer assisted software to enable pattern analysis and lesion distributions. The OCT images will be graded quantitatively and qualitatively for area, amount and site of retinal thickening which will assess the sensitivity and specificity of the surrogate markers. Software will be developed to analyse the distribution of retinal lesions in order to find the significance of photographic marker patterns on the likelihood of CSMO.
The study is due to run for two years. For further information visit http://www.abdn.ac.uk/ismo
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Rebecca Leigh is currently conducting a research project investigating the progression of early exudate lesions in the macula. Follow up of patients on a six month recall will identify if the early exudate lesions have progressed to clinically significant macula oedema (CSMO) or have remained unchanged.
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In the English National Screening Programme for Diabetic Retinopathy, differences of outcome and grades may occur following first and second full disease grading. Karen Whitehouse has conducted research upon arbitration grading to assess both grade and referral outcome to evaluate primary and secondary grading accuracy. To see Karen Whitehouse's poster please click here
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Helen King is currently monitoring all pregnant patients within East Birmingham PCT, South PCT, Heart of Birmingham PCT and Solihull PCT to confirm the effectiveness of the pregnancy protocol
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