Diabetic retinopathy screening: current screening practices and novel retinal imaging modalities

[Truncated] Diabetes is a metabolic disease that is rapidly increasing in prevalence. One in four people with diabetes will develop diabetic retinopathy (DR). Therefore, it is important for primary eye care providers, such as optometrists and general practitioners (GPs), to actively participate in screening services by performing dilated fundoscopy or retinal imaging. Retinal cameras are generally expensive and technically challenging to operate; thus, they are often not readily available in the primary health care setting, especially in rural areas. The aim of this thesis is to evaluate the current DR screening practices and attitudes of primary eye care providers and validate some novel, costeffective and easy-to-operate imaging technologies as alternative screening tools that can potentially increase their interest and desire in DR screening.

Section 1 evaluates the current management practices of Australian optometrists (Chapter 1) and GPs (Chapter 2). A total of 3,000 self-administered questionnaires consisting of questions related to screening practices/attitudes and hypothetical clinical scenarios were mailed out to optometrists (n=1,000) and GPs (n=2,000) across Australia. The results showed that nearly 78% of optometrists reported having a strong desire to screen for DR, compared to only 40% of GPs. The leading screening barriers for GPs and optometrists were: 1) poor confidence in performing direct ophthalmoscopy; 2) time limitations; 3) patients’ unpreparedness to drive; and 4) the fear of inducing angle-closure glaucoma. The use of a retinal camera was shown to significantly increase optometrists’ confidence to detect DR changes. Further research should focus on the identified barriers in order to allow early detection of sight-threatening DR that requires prompt laser treatment to prevent severe visual impairment.