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C S Arun

Publications and source records attributed to C S Arun.

6 recordsLinked to original sources
PubMed2006

Establishing ongoing quality assurance in a retinal screening programme.

AIM: To establish a clinically efficient, cost-effective quality assurance programme as part of a routine retinopathy screening service. METHODS: The operation of a quality assurance system as part of an ongoing retinal screening service is described. A random selection of 12% of images of all people reported to have retinopathy and of 2% reported to have no retinopathy are re-graded by a consultant ophthalmologist. Entry of the two sets of data into a purpose-designed excel spreadsheet allows automated calculation of sensitivity and specificity. RESULTS: The results of quality assurance from August 2001 to July 2003 are reported. Out of 8351 screening episodes, 498 were re-examined. Of the 62 cases identified by the ophthalmologist as having referable retinopathy, four false negatives for detection were identified. Three of these had been assigned to early re-screening by the retinal screener but were still regarded as false negative by the parameters of the quality assurance system. The sensitivity and specificity for detection of sight-threatening retinopathy were 93.5% (95% CI = 84.3-98.2%) and 97.8% (95% CI = 95.8-98.9%), respectively. CONCLUSION: A robust and cost-effective system has been developed to allow monitoring of performance of routine retinal screening which may be extended to meet current national recommendations.

Diabetic Retinopathy↗
PubMed2004

Long-term progression of retinopathy after initiation of insulin therapy in Type 2 diabetes: an observational study.

AIMS/HYPOTHESIS: Universal worsening of retinopathy after starting insulin therapy in Type 2 diabetes has been suggested in previous work. METHODS: We studied 294 such patients for up to 5 years to evaluate retinal changes and define the factors affecting progression of retinopathy. Yearly retinal photographs were graded using the EURODIAB system. RESULTS: Prior to insulin therapy, 26.2% (77/294) of the patients had minimal non-proliferative diabetic retinopathy (NPDR), 3.7% (n=11) had moderate NPDR and 1% (n=3) had severe NPDR. Over the first 3 years of insulin therapy, significant progression occurred in 36 subjects (12.6%). This comprised 5/193 (2.6%) without any retinopathy at baseline, 22/77 (28.5%) with minimal NPDR and 6/11 with moderate NPDR (54.5%) (chi2=56.1, p<0.001). In a control group of 70 patients who remained on oral hypoglycaemic agents, nine patients had significant worsening of retinopathy over 3 years. Over 5 years, 22/127 (17.3%) of patients (9/95 without and 13/32 with retinopathy at baseline [chi2=16.2, p<0.001]) had significant progression of retinopathy. Higher baseline HbA1c (p=0.002) and lower initial decrease in HbA1c (p=0.007) were each independent predictors of greater retinopathy progression over this period. There was no significant worsening of visual acuity in patients whose retinopathy progressed. CONCLUSIONS/INTERPRETATION: After initiation of insulin treatment in Type 2 diabetes, clinically significant worsening of retinopathy over a 3-year period was uncommon in those with no retinopathy (2.6%) but occurred in 31.8% of patients with any retinopathy at baseline. The risk of serious worsening of retinopathy after insulin therapy is started in all patients with Type 2 diabetes may have been previously overestimated.

Administration, Oral↗
PubMed2003

Effectiveness of screening in preventing blindness due to diabetic retinopathy.

AIMS: Diabetes remains the commonest cause of blindness in the working age population of the UK, but little information exists about the individuals who are currently losing sight from this cause. We determined the current blindness incidence (1998-2000) in Newcastle Health District and the clinical characteristics of these patients. METHODS: Data were collected for 1998-2000 from the Royal National Institute for the Blind Liaison Office of the Newcastle Ophthalmology Department. The Ophthalmology Clinic notes on each individual were retrieved to verify clinical details, including previous eye diagnosis, dates of previous laser photocoagulation and eye surgery. The diabetes clinical records were studied to obtain information on type and duration of diabetes, blood pressure, HbA1c and other biochemical parameters. To ensure completeness of data, details of all patients registered blind attending the Newcastle Diabetic Centre were examined. RESULTS: Twenty-eight patients were registered blind due to diabetes and 26 partially sighted during this period. The annual incidence of blindness and partial sightedness due to diabetes in the Newcastle district were 0.35 and 0.56 per 1000, respectively. The average ages in the two groups were 65.9 +/- 12.5 and 67.2 +/- 12.3 years and duration of diabetes 15.5 +/- 13.9 and 15.3 +/- 10.6 years, respectively. Proliferative retinopathy accounted for 30 and maculopathy for 24 registrations. The times from ophthalmology referral to registration were 6.2 +/- 3.5 and 4.4 +/- 3.3 years in these groups, respectively. No cases resulted from false-negative screening. CONCLUSIONS: In Newcastle district, where the retinal screening programme has been running since 1986, the rates of blindness and partial sightedness are less than one-third of those reported in the surveys prior to 1997, confirming that objectives of the St Vincent's declarations are being achieved.

Aged↗