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Clinical trial provides new approach for people with eye disease that increases NHS capacity

A UK-wide clinical diagnostic study, funded by the NIHR, has shown how a new surveillance pathway for people with stable diabetic eye disease is safe and cost-saving, freeing up ophthalmologists to evaluate and treat people requiring urgent care.

The new healthcare surveillance pathway may help ophthalmic units across the world to improve their capacity while saving patient’s sight. It is already having a positive impact on the re-design of NHS services across the UK, having been implemented successfully in several hospitals.

The research, led by researchers at Queen’s University Belfast, has been published in leading journals including Ophthalmology and the British Journal of Opthalmology.

The EMERALD (the Effectiveness of Multimodal imaging for the Evaluation of Retinal oedemA and new VesseLs in Diabetic retinopathy) diagnostic accuracy study tested a new ‘ophthalmic grader’ pathway. Rather than involving ophthalmologists, this pathway uses trained graders to monitor people with previously treated and stable complications of diabetic eye disease, namely diabetic macular oedema and proliferative diabetic retinopathy, based on the reading of images and scans of the back of their eyes. 

In EMERALD, ophthalmic grader’s performance was comparable to results produced with  standard care (i.e., ophthalmologists evaluating patients in clinic).

Professor Noemi Lois, lead researcher and Clinical Professor of Ophthalmology from the Wellcome-Wolfson Institute for Experimental Medicine at Queen’s University Belfast, explains: “Diabetic macular oedema and proliferative diabetic retinopathy, the main sight-threatening complications of diabetic retinopathy, can cause blindness if left untreated. It is therefore important to diagnose them and to treat them timely. Currently, ophthalmologists need to evaluate all patients, even those that are stable after treatment and who are doing well. 

“EMERALD showed trained ophthalmic graders are able to determine whether patients with diabetic macular oedema or proliferative diabetic retinopathy previously successfully treated remain stable or if the disease has reactivated. Thus, they would be able to follow people that have been already treated, releasing ophthalmologists’ time. Ophthalmologists could then use this time to treat other patients, for example, those who have indeed diabetic macular oedema or active proliferative diabetic retinopathy and who have not yet received treatment saving their sight.”

The EMERALD study was set in 13 NHS hospitals across the UK and is a large multicentre, UK-wide diagnostic accuracy study funded by the NIHR Health Technology Assessment programme.