Ambulatory photographic screening for diabetic retinopathy in nursing homes

Eye (Lond). 2003 Aug;17(6):711-6. doi: 10.1038/sj.eye.6700487.


Purpose: 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.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Ambulatory Care / economics
  • Ambulatory Care / organization & administration*
  • Diabetic Retinopathy / diagnosis*
  • Diabetic Retinopathy / epidemiology
  • Diabetic Retinopathy / physiopathology
  • England / epidemiology
  • Feasibility Studies
  • Health Care Costs
  • Health Services for the Aged / economics
  • Health Services for the Aged / organization & administration*
  • Homebound Persons
  • Humans
  • Nursing Homes*
  • Photography
  • Prevalence
  • Severity of Illness Index
  • Vision Screening / economics
  • Vision Screening / methods*
  • Vision Screening / organization & administration
  • Visual Acuity