Continuing Professional DevelopmentCurrent Issues

As part of the CPD scheme we will distribute at regular intervals one of these Current Issues worksheets. These are designed to provide the members of IMI with a structured CPD activity to help develop your CPD portfolio. It is recognised that this worksheet requires some time spent obtaining and reading a number of publications. As a way of ensuring that the allocated time has been spent on the activities a number of self-assessment exercises (SAEs) have been included. The answers to the SAEs, along with any notes you make or other publications you find, should be kept in your CPD portfolio.

If you have difficulty in obtaining any of the publications contact the CPD Co-ordinator.

Diabetic Retinopathy screening

The photographic screening of patients with diabetes, has become a valuable tool for the Ophthalmologist in detecting early signs of Diabetic Retinopathy (DR). Community DR screening schemes have been running for many years across the UK. Medical photographers using retinal fundus cameras record each retina according to a set protocol of a number of fields (views) determined by the Ophthalmologist. One protocol is the ‘gold standard’ Airlie House seven fields specification that includes the macula and the vascular arcades of each retina to detect early lesions. But many screening schemes use considerably fewer fields.

There are various recording methods for DR screening available to the medical photographer. The two main types of fundus camera used for screening are the mydriatic (mydriasis – using pharmalogical preparations to achieve dilation) and non-mydriatic (using dark adaptation to achieve dilation) cameras. This can be achieved using Polaroid instant prints, 35mm transparencies and digital image capture.

A reading list follows. These articles are a selection from a large amount of literature available on DR screening, particularly from diabetes and ophthalmologysources. You are not expected to read all of them.

Younis N, Broadbent DM, James M, Harding SP and Vora JP. Current status of screening for diabetic retinopathy in the UK. Diabetic Med 2002; 19(Suppl. 4) 44-49.

Clements C, Prince CB, Prasad S, Aralikatti A, Swindlehurst H, and Clearkin LG. Letters. Br Med J 2002; 324: 849. http://bmj.com/cgi/content/full/324/7341/849

White NC. The potential impact of a National Diabetic Retinopathy Screening Programme on a department of medical illustration. J Audiov Media Med 2002; 25:1 24-27.

Herd H and Aldington SJ. Screening for diabetic retinopathy; developing a standardized photographic protocol for St. John’s Hospital. J Audiov Media Med 2002; 25:1 28-33.

Associated UK National Screening Committee's (NSC) website ‘Preservation of Sight in Diabetes: a risk reduction programme’http://www.diabetic-retinopathy.screening.nhs.ukhttp://www.diabetic-retinopathy.screening.nhs.uk/overview-of-screening-models.html#photography

Gomez-Ulla F, Fernandez MI, Gonzalez F, Rey P, Rodriguez M, Rodriguez-Cid MJ, Casanueva FF, Tome MA, Garcia-Tobio J, and Gude F. Digital Retinal Images and Teleophthalmology for Detecting and Grading Diabetic Retinopathy. Diabetes Care 2002; 25:8 1384–1389http://care.diabetesjournals.org/cgi/reprint/25/8/1384.pdf

Stellingwerf C, Hardus PLLJ, and Hooymans JMM. Two-Field Photography Can Identify Patients With Vision-Threatening Diabetic Retinopathy: A screening approach in the primary care setting. Diabetes Care 2001; 24:12 2086-2090. http://care.diabetesjournals.org/cgi/reprint/24/12/2086.pdf

Liesenfeld B, Kohner E, Piehlmeier W, Kluthe S, Aldington S, Porta M, Bek T, Obermaier M, Mayer H, Mann G, Holle R, and Hepp KD. A telemedical approach to the screening of diabetic retinopathy: digital fundus photography. Diabetes Care 2000; 23:3 345-348.

Task: Read the following publications and then attempt the SAEs

George LD, J Lusty, Owens DR and Ollerton RL. Effect of software manipulation (Photoshop) of digitised retinal images on the grading of diabetic retinopathy. Br J Ophthalmol 1999; 83: 911–913.http://bjo.bmjjournals.com/cgi/reprint/83/8/911.pdf

Taylor DJ, Fisher J, Jacob J and Tooke JE. The use of digital cameras in a mobile retinal screening environment. Diabetic Med 1999; 16: 680-686.

George LD, Halliwell M, Hill R, Aldington SJ, Lusty J, Dunstan F. A comparison of digital and 35 mm colour transparencies in detecting and grading diabetic retinopathy. Diabetic Med 1998; 15: 250-253.

Ryder REJ, Kong N, Bates AS, Sim J, Welch J, Kritzinger EE. Instant electronic imaging systems are superior to Polaroid at detecting sight threatening diabetic retinopathy. Diabetic Med 1998; 15: 254-258.

Ryder B. Screening for diabetic retinopathy [editorial]. Br Med J 1995; 311: 207-208.http://bmj.com/cgi/content/full/311/6999/207

Harding SP, Broadbent DM, Neoh C, White MC, Vora J. Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease. The Liverpool diabetic eye study. Br Med J 1995; 311: 1131-1135. http://bmj.com/cgi/content/full/311/7013/1131

Ellingford A. Diabetic photographic eye screening using a mobile unit in Tayside, Scotland. J Audiov Media Med 1992; 15: 104-107

Williams R. Nussey S. and Thompson G. Assessment of non-mydriatic fundus photography in detection of diabetic retinopathy. Br Med J 1986; 293(1 Nov): 1140.

Barrie T. and MacGuish A.C. Letter re: Assessment of non-mydriatic fundus photography in detection of diabetic retinopathy. BMJ 1986; 293(15 Nov): 1304-5 (Correspondence)

Williams R. Nussey S. and Thompson G. Reply to Barrie and MacGuish’s Letter. BMJ 1986; 293(13 Dec): 1571 (Correspondence)

Cheng H. and Franklin S. Reply to Barrie and MacGuish’s Letter. BMJ 1986; 293(13 Dec): 1571-2 (Correspondence).

SAEs

1. Briefly compare the characteristics of the non-mydriatic and mydriatic fundus camera when used for DR screening.

2. Compare the merits of Polaroid, 35mm slides and digital when used in grading the signs of DR in patients. Note the sensitivity of photographic screening compared to ophthalmoscopy for grading DR that is quoted in articles. You should read articles and correspondence from both medical photography journals and medical journals that assess the quality and value of each type of method.

Ryder REJ. Reply to Barrie and MacGuish’s Letter. BMJ 1986; 293(13 Dec): 1572 (Correspondence).

Ryder REJ, Young S, Vora JP, Atlea JA, Owens DR and Hayes TM. Screening for diabetic retinopathy using Polaroid retinal photography through undilated pupils. Practical Diabetes 1985; (2:5) 34-39.

You should record this work in your portfolio. CPD portfolios will be selected at random for review by the CPD Co-ordinator..

If you have any comments (positive or negative) about this worksheet please pass them to the CPD Co-ordinator, we value your feedback and it will help us in developing future worksheets. If you have any suggestions for topics that we should consider for the next worksheet please also pass these to the CPD Co-ordinator.