Grading and disease management in national screening for diabetic retinopathy in England and Wales.
OBJECTIVE
A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight-threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false-positive referral to the hospital eye service.


METHODS
Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications.


METHODS
Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no 'questionable' lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight-threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight-threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1).


CONCLUSIONS
The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality-assured screening for people with diabetes.
Harding
S
S
St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. simonharding@aol.com
Greenwood
R
R
Aldington
S
S
Gibson
J
J
Owens
D
D
Taylor
R
R
Kohner
E
E
Scanlon
P
P
Leese
G
G
D002985:Clinical Protocols; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000473:pathology; D004739:England; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008028:Light Coagulation; D008268:Macular Degeneration / Q000175:diagnosis / Q000473:pathology; D008403:Mass Screening / Q000379:methods* / Q000458:organization & administration; D009313:National Health Programs; D011785:Quality Assurance, Health Care / Q000379:methods; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000379:methods; D014852:Wales