title: Ambulatory photographic screening for diabetic retinopathy in nursing homes.
abstract: OBJECTIVE
  To evaluate the feasibility and cost of screening for diabetic eye disease in homebound nursing home residents not attending a systematic screening programme.
  
  
  METHODS
  Postal survey identification of residents with diabetes in all nursing homes in Liverpool. An ophthalmologist and nurse performed Bailey-Lovie logmar visual acuity (VA), portable slit-lamp examination, fundus photography, and subjective assessment of ability to cooperate with treatment in a sample of homes. Modified Wisconsin photographic grading was performed. Screen-positive patients were invited to a dedicated assessment clinic. Sight-threatening diabetic eye disease (STED) was defined as any of: moderate preproliferative retinopathy or worse, circinate maculopathy, or exudate within 1 disc diameter of fixation.
  
  
  RESULTS
  A total of 54 (78%) nursing homes responded reporting 199/2427 (8.2%) residents with diabetes. Of these, 64/80 (80%) residents in 17 homes were examined: VA possible in 50 (78%); slit-lamp examination in 56 (88%); gradable photographs in at least one eye in 34 (53%); STED in 12 (35%) patients. In all, 35 (70%) patients had Snellen-equivalent VA worse than 6/12 in the better eye, of whom 13 (26%) were worse than 6/60. Of 29 screen positive patients, 12 attended the assessment clinic: one was unable to cooperate outside the home; 11 continue under ophthalmic review, four for previously undetected STED of which one listed for laser photocoagulation. Total cost pound 16,980; cost per screen event pound 60.30.
  
  
  CONCLUSIONS
  Systematic eye screening in homebound patients with diabetes detects disease but follow-up and treatment is only feasible in a small proportion and at high cost. Alternative targeted assessment is recommended.
authors.affiliation: St Paul's Eye Unit Royal Liverpool University Hospital Liverpool, UK.
authors.forename: S
authors.initials: S
authors.lastname: Anderson
authors.forename: D M
authors.initials: DM
authors.lastname: Broadbent
authors.forename: J Y S
authors.initials: JY
authors.lastname: Swain
authors.forename: J P
authors.initials: JP
authors.lastname: Vora
authors.forename: S P
authors.initials: SP
authors.lastname: Harding
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D004739:England / Q000453:epidemiology; D005240:Feasibility Studies; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration*; D018577:Homebound Persons; D006801:Humans; D009735:Nursing Homes; D010781:Photography; D015995:Prevalence; D012720:Severity of Illness Index; D015351:Vision Screening / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D014792:Visual Acuity