Non-attendance at diabetic retinal screening in Te Tai Tokerau, Northland, Aotearoa New Zealand.

AIMS: To explore socio-demographic characteristics of non-attenders at diabetic retinal screening. METHODS: A retrospective, register-based cross-sectional analysis of 10,275 participants invited to diabetic retinal screening in Te Tai Tokerau (Northland) between May 2011 and June 2020 was performed. Multivariable logistic regression analysis was used to assess the association of age, sex, type of diabetes, ethnicity and socio-economic deprivation with non-attendance at diabetic retinal screening. RESULTS: Median age was 66 years and 54.3% of participants were male. The non-attendance rate was 26.4%, with 46.6% of individuals having at least one non-attendance. Younger age was associated with higher odds of non-attendance (OR 1.84 95% CI 1.41-2.40, <0.001 for odds of non-attendance in those aged under 35 years compared with age over 75 years). Maori (OR 2.69, 95% CI 2.44-2.96, p<0.001) and Pacific peoples (OR 1.71, 95% CI 1.25-2.36, p=0.001) had higher odds of non-attendance compared with NZ Europeans. People living in areas of high socio-economic deprivation had higher odds of non-attendance (OR 1.56, 95% CI 1.33-1.82, p<0.001), as did type 1 diabetics (OR 1.31, p5% CI 1.08-1.59, p=0.006). CONCLUSION: Younger age, socio-economic deprivation, type 1 diabetes and Maori and Pacific ethnicity are risk factors for nonattendance at diabetic retinal screening.

PSEUDOXANTHOMA ELASTICUM: SUCCESSFUL LONG-TERM MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO ANGIOID STREAKS WITH PRO RE NATA INTRAVITREAL BEVACIZUMAB INJECTIONS.

PURPOSE: To demonstrate how a patient with recurrent episodes of choroidal neovascularization (CNV), secondary to angioid streaks, can be managed successfully with a pro re nata regime of intravitreal bevacizumab injection over an eight-year period. METHOD: A 32-year-old white woman with pseudoxanthoma elasticum has been followed up over an eight-year period for management of recurrent episodes of CNV in both eyes. She was educated to recognize the early signs and symptoms of CNV. Physical examination including visual acuity and slit-lamp examination as well as investigations such as macula optical coherence tomography and optical coherence tomography angiography were performed. Bevacizumab injections were given to her when she was diagnosed with CNV. RESULTS: Multiple episodes of CNV were successfully treated with pro re nata regimes of intravitreal bevacizumab injections. The patient was able to maintain excellent visual acuity of 0 logarithm of the minimum angle of resolution even after suffering recurrent episodes of CNV. CONCLUSION: This case report supports that a pro re nata regime of intravitreal bevacizumab injection therapy can be used successfully to treat recurrent episodes of CNV in a patient with pseudoxanthoma elasticum over an eight-year period. Early diagnosis through patient education and the use of appropriate diagnostic tools such as optical coherence tomography angiography have enabled us to deliver early treatment, resulting in an excellent outcome for this patient.

Discharge outcomes of patients referred to specialist eye clinic from diabetic retinopathy screening in Northland (2014-15).

AIMS: To determine the discharge outcomes of patients seen in specialist eye clinic after referral from diabetic retinopathy screening (DRS). METHODS: Retrospective analysis of outcomes of a sample of 98 patients referred from DRS to specialist eye clinic. RESULTS: A sample of 98 patients were analysed following referral by DRS to specialist eye clinic from 16/4/14 to 16/4/15. Age at screening ranged from 13-88 years, with the main ethnic groups being Maori (57.1%), European (39.79%) and Indian (3.06%). A majority of the patients were referred to specialist eye clinic for diabetic retinopathy (60%) or cataracts (35%). After being seen in specialist eye clinic, 45% of the patients were enrolled back into DRS and 49.1% stayed under care of ophthalmology service for further treatment, and a further 5.9% were discharged to care of GP or optometrist without re-enrolment back to DRS. Of those referred back to DRS, 30% were re-enrolled after further imaging with optical coherence tomography (OCT), and 24% of patients were referred back to DRS due to non-attendance. Non-attendence at clinic appointments was high among the Maori population. CONCLUSION: Our study identified that 94% of patients referred to specialist eye clinic were either referred back to DRS or kept under care with only five patients not re-enrolled back into DRS. Despite good service delivery, Northland remains a high-risk population for diabetes, where non-attendance at clinic appointments remained an issue with the Maori patient population. In addition, a significant proportion of patients were re-referred back to DRS after OCT, and a consideration is to include OCT in the screening pathway.

Prevalence of diabetic retinopathy and maculopathy in Northland, New Zealand: 2011-2012.

AIM: To determine the prevalence of diabetic retinopathy and maculopathy in the Northland Diabetic Retinopathy Screening Programme. METHOD: Retrospective analysis of the latest and most severe retinopathy and maculopathy grades from each patient in the programme. RESULTS: Data from 7098 screenings from 5647 diabetics were obtained, which represented approximately 77% of the total number of diagnosed diabetics in Northland. The two main ethnic groups in our study were New Zealand European (56.5%) and Maori (39.3%). Retinopathy was present in 19% of the Northland diabetic screening population: 13.6% had minimal non-proliferative diabetic retinopathy (NPDR), 5.4% had NPDR and 0.4% had Proliferative Diabetic Retinopathy (PDR). Ethnicity data for NPDR was 57% Maori, 38% European, and PDR 50% Maori, 45% European. Maculopathy was present in 11%. Maculopathy requiring treatment was present in 1.4% (Maori 48%, European 44%). The mean failure-to-attend rate was 31%. CONCLUSION: Rates of retinopathy and maculopathy detected by the Northland screening programme were comparable to rates reported in Waikato, lower than Wellington rates and lower than international averages. Maori were over-represented in patients with retinopathy and maculopathy, but underrepresented within the screening population. The success of this programme was undermined by the high failure-to-attend rate despite attempts to improve access.