Screening for Diabetic Screening for Diabetic Retinopathy in EuropeRetinopathy in Europe

Progress since 2005Progress since 2005

Report from National Report from National Representatives MeetingRepresentatives Meeting

Simon HardingSimon Harding

Amsterdam 30th May 2008

The St. Vincent DeclarationThe St. Vincent Declaration

Implement effective measures for the prevention of Implement effective measures for the prevention of costly complicationscostly complications

Reduce new blindness due to diabetes by one third or more

General Goal for people with diabetesGeneral Goal for people with diabetesSustained improvement in health experience and life

approaching normal expectation in quality and quantity

Liverpool 2005Liverpool 2005

Liverpool Town Hall 17-18th November 2005

The Liverpool DeclarationThe Liverpool Declaration

European countries should:

Reduce the risk of visual impairment due to diabetic retinopathy by 2010 through:

• systematic programmes of screening reaching at least 80% of the population with diabetes

• using trained professionals and personnel

• universal access to laser therapy

Three componentsThree components

Organisation

Personnel

Equipment, tests and treatment

www.drscreening2005.org.uk

www.drscreening.eu

ImplementationImplementation

• Establish joint meetingsEstablish joint meetings• Set up training programmesSet up training programmes• Move from local to regional to national Move from local to regional to national

implementationimplementation• Establish policy including defined goalsEstablish policy including defined goals• Set national guidelinesSet national guidelines• Agree timeframeAgree timeframe• Don’t give up!Don’t give up!

30 May 2008Amsterdam

Conference objectivesConference objectives

To review Liverpool Declaration targets and report on progress To describe obstacles to implementation

To develop further guidance

To engage stakeholders

DelegatesDelegates

46 European countries invited• diabetologist, ophthalmologist

26 European countries represented67 delegates

Groups of NationsGroups of Nations

Group 1Group 1

Czech Republic, Hungary, Poland, Serbia, TurkeyCzech Republic, Hungary, Poland, Serbia, Turkey

Group 2Group 2

Denmark, England, Finland, Iceland, Scotland, Denmark, England, Finland, Iceland, Scotland, Sweden, Wales Sweden, Wales

Group 3Group 3

Belgium, France, Greece, Ireland, Italy, Luxembourg, Belgium, France, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, (Germany, Israel, Spain)Netherlands, Portugal, (Germany, Israel, Spain)

Group 4Group 4

Albania, Belarus, Bulgaria, Georgia, LithuaniaAlbania, Belarus, Bulgaria, Georgia, Lithuania

30 May 2008Amsterdam

Key messagesKey messages

Significant progress made since 2005Significant progress made since 2005

Nearly all countries have taken a step forward:Nearly all countries have taken a step forward:• established systematic screeningestablished systematic screening• developing local to regional to nationaldeveloping local to regional to national• patchy progress:patchy progress:

– development of national guidelinesdevelopment of national guidelines– training programmes being startedtraining programmes being started– regional/national implementation groupsregional/national implementation groups

This has been led by a small/medium groups of This has been led by a small/medium groups of champions in each countrychampions in each country

30 May 2008Amsterdam

~1/3 report likely to achieve 2010 targets, others part~1/3 report likely to achieve 2010 targets, others part

Key messagesKey messages

Wide variation in prevalenceWide variation in prevalence• 3-5% majority3-5% majority• 7.9% Belgium, 6.9% Portugal, 7% Georgia 7.9% Belgium, 6.9% Portugal, 7% Georgia • 9.0% Finland high frequency of type 19.0% Finland high frequency of type 1• >10% Greece>10% Greece• PDR 23.5% in Czech RepublicPDR 23.5% in Czech Republic• <2% in Belarus, Bulgaria, Lithuania; <1% in <2% in Belarus, Bulgaria, Lithuania; <1% in

AlbaniaAlbania

Expected big increaseExpected big increase

30 May 2008Amsterdam

Key messagesKey messages

Access to laser still poor in a few countriesAccess to laser still poor in a few countries

Problems with continued secure funding in long Problems with continued secure funding in long established programmes (Iceland)established programmes (Iceland)

Some bizzare perverse incentivesSome bizzare perverse incentives• avastin/TA being given even when laser is avastin/TA being given even when laser is

availableavailable

30 May 2008Amsterdam

Issues identifiedIssues identified

Public awarenessPublic awareness

Patient compliancePatient compliance

Lack of funding for equipment, training, educationLack of funding for equipment, training, education

Collaboration between ophthalmologists and Collaboration between ophthalmologists and diabetologistsdiabetologists

Lack of engagement of private providers of eye careLack of engagement of private providers of eye care

systematic process, competency, registers, datasystematic process, competency, registers, data

Political instabilityPolitical instability

30 May 2008Amsterdam

Recommendations Group 1Recommendations Group 1

Raise awareness of diabetes and retinopathy •particularly primary care providers•also patients and public

Adequate funding for lasers and fundus cameras•(personnel not such an issue)

Establish call recall systems as the key method of the development of diabetes registers•can only be achieved by moving from local to regional to national

Recommendations Group 2Recommendations Group 2

For established screening programmes:

Quality improvement plan against explicit measureable standards across all components of screening and management•focus on management of screen positive cases

Comprehensive list of people with diabetes with regular maintenance

Integrate eye screening results with general diabetes care

Recommendations Group 3Recommendations Group 3

Develop registers of people with diabetes•consider alternative sources of data: pharmacy, pharmaceutical data, insurance data•unique identifiers•local – regional – national

Engage private eye care providers•involve health insurers in establishing systematic screening•guidelines for all professional groups should require fundus imaging at the agreed frequency•data transmission to a linked independently funded database•ensure no requirement to refer screen +ve patients

Recommendations Group 4Recommendations Group 4

Raise awareness of diabetes and retinopathy •particularly with patient groups

Adequate funding for lasers and fundus cameras•particularly for training programmes

Governments should fund the development and adoption of guidelines•funding can be better utilised if the frequency of screening can be reduced

Mobile screening is most relevant to rural areas

How can we make further progress?How can we make further progress?

European Organisations Representatives: Dr. Christoph Steffen, European Commission, Information Society & Media DGDr. Wim Wientjens, Vice President, International Diabetes FoundationDr. Ivo Kocur, Prevention of Blindness and Deafness (PBD), World Health OrganisationDr. Karl-Jurgen Schmitt, Chairman, Structural Funds Task Force, COCIR

Where next?Where next?

draft conference report circulated to national representatives final report circulated to key European organisationswebsite will post abstracts and presentations

next meeting in 2011 to review 2010 targets

Organising CommitteeOrganising Committee

Organising CommitteeDeborah Broadbent, Simon Harding, Ken Swa, Bettine Polak, Annette Moll

ModeratorsDeborah Broadbent, Eva Kohner, Ken Swa, Simon Harding

Conference SecretariatLindy Gee, Jitta Reddingius, Ingrid van Vegde

Thank you