title: Screening for diabetic retinopathy in pregnancy using photographic review clinics.
abstract: OBJECTIVE
  To assess the efficacy and value of the National Institute for Health and Clinical Excellence guidelines for digital photographic screening for diabetic retinopathy in pregnancy using photographic review clinics.
  
  
  METHODS
  Pregnant patients (n = 186) with known diabetes were screened at first antenatal visit and at 28 weeks' gestation, if no retinopathy was noted at first visit, or at other intervals if retinopathy was present. Two 45° images (disc-centred and macula-centred views) were taken in both eyes and graded by trained graders and by an ophthalmologist.
  
  
  RESULTS
  Ninety-three patients (50%) remained free of diabetic retinopathy throughout pregnancy. Eighteen (10%) presented with sight-threatening retinopathy at their first antenatal screen and were referred to the hospital eye service. Fifty patients (27%) were shown to have relatively stable retinopathy throughout pregnancy, with only two patients deteriorating and requiring referral to hospital eye service. Twenty-three (12%) failed to complete the screening protocol after their first screen.
  
  
  CONCLUSIONS
  The study showed that pregnant patients screened for retinopathy in an ophthalmic photographic diabetic review clinic achieved National Institute for Health and Clinical Excellence guidelines in the majority and were clinically safe. Only 1% of patients required referral to ophthalmology after their initial screen, thus avoiding unnecessary hospital eye service appointments.
authors.affiliation: Birmingham, Solihull and Black Country Diabetic Retinal Screening Programme, Heart of England Diabetic Retinopathy Screening Centre, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hampshire
authors.forename: H
authors.initials: H
authors.lastname: Wharton
authors.forename: R
authors.initials: R
authors.lastname: Leigh
authors.forename: A
authors.initials: A
authors.lastname: Wright
authors.forename: P
authors.initials: P
authors.lastname: Dodson
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D010781:Photography / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000175:diagnosis*; D011296:Prenatal Diagnosis / Q000379:methods; D012189:Retrospective Studies; D015351:Vision Screening / Q000379:methods