Proliferative diabetic retinopathy (R3) referrals from the digital diabetic retinopathy screening program:urgency of appointment in the hospital eye service achieved and needed?

DESIGN. Retrospective analysis PURPOSE. To assess the clinical characteristics and outcomes of patients identified with proliferative diabetic retinopathy (PDR) referred from the screening program to the hospital eye services (HES) METHODS. a retrospective analysis of urgently referred PDR cases to Birmingham Heartlands HES from august 2008 until July 2010 RESULTS. 130 urgent diabetic retinopathy referrals were made and reviewed. 103 (68% male, 80% type 2 diabetes) were referred for PDR with a mean age of 59 years, mean diabetes duration of 17.8years. 69% were on insulin treatment at the time of the screening, with mean HbA1c of 10.4% (range-5.7 to 16.5%). 65% of the patients were offered appointments at HES within two weeks after referral from the screening. 50.5% of the patients were seen in the HES within 2 weeks, 22 and 16 % were seen 2-4 and 4-8 weeks after referral respectively. 6 patients never attended ophthalmology examination during the two years of review. Of all the attendees, 56% were booked for pan retinal photocoagulation (PRP) & 9(9.3%) for macular laser respectively on their 1st HES visit. 75% of the patients were newly diagnosed PDR and 26 had previous PRP laser but lost to follow up. 63 patients ( 66%) received either PRP or macular laser treatment (85.7% of which is PRP). 63% of the PRP treatment was performed within a month of first HES attendance. Retinopathy grading discrepancy between the screening program and HES was noted in 20% (21 patients). CONCLUSIONS. This data suggests that the digital screening programme is appropriately identifying high risk patients with PDR with timely PRP laser treatment in the majority of patients but raises concern over patients lost to follow up (hence failsafe tracking of appointment attendance), and review of grading discrepancies between the ophthalmology and screening service.

Image enhancement of real-time television to benefit the visually impaired

Purpose: To examine the use of real-time, generic edge detection, image processing techniques to enhance the television viewing of the visually impaired. Design: Prospective, clinical experimental study. Method: One hundred and two sequential visually impaired (average age 73.8 ± 14.8 years; 59% female) in a single center optimized a dynamic television image with respect to edge detection filter (Prewitt, Sobel, or the two combined), color (red, green, blue, or white), and intensity (one to 15 times) of the overlaid edges. They then rated the original television footage compared with a black-and-white image displaying the edges detected and the original television image with the detected edges overlaid in the chosen color and at the intensity selected. Footage of news, an advertisement, and the end of program credits were subjectively assessed in a random order. Results: A Prewitt filter was preferred (44%) compared with the Sobel filter (27%) or a combination of the two (28%). Green and white were equally popular for displaying the detected edges (32%), with blue (22%) and red (14%) less so. The average preferred edge intensity was 3.5 ± 1.7 times. The image-enhanced television was significantly preferred to the original (P < .001), which in turn was preferred to viewing the detected edges alone (P < .001) for each of the footage clips. Preference was not dependent on the condition causing visual impairment. Seventy percent were definitely willing to buy a set-top box that could achieve these effects for a reasonable price. Conclusions: Simple generic edge detection image enhancement options can be performed on television in real-time and significantly enhance the viewing of the visually impaired. © 2007 Elsevier Inc. All rights reserved.