Amsterdam 30th May 2008

1. Screening for Diabetic Retinopathy in EuropeProgress since 2005Report from National Representatives MeetingSimon Harding Amsterdam 30th May 2008

2. The St. Vincent Declaration General Goal for people with diabetes Sustained improvement in health experience and life approaching normal expectation in quality and quantity Implement effective measures for the prevention of costly complications Reduce new blindness due to diabetes by one third or more

3. Liverpool 2005 Liverpool Town Hall 17-18th November 2005

4. The Liverpool Declaration European countries should: • Reduce the risk of visual impairment due to diabetic retinopathy by 2010 through: • systematic programmes of screening reaching at least 80% of the population with diabetes • using trained professionals and personnel • universal access to laser therapy

5. Three components Organisation Personnel Equipment, tests and treatment www.drscreening2005.org.uk www.drscreening.eu

6. Implementation • Establish joint meetings • Set up training programmes • Move from local to regional to national implementation • Establish policy including defined goals • Set national guidelines • Agree timeframe • Don’t give up! Amsterdam

7. Conference objectives To review Liverpool Declaration targets and report on progress To describe obstacles to implementation To develop further guidance To engage stakeholders

8. Delegates • 46 European countries invited • diabetologist, ophthalmologist • 26 European countries represented • 67 delegates

9. Groups of Nations Group 1 Czech Republic, Hungary, Poland, Serbia, Turkey Group 2 Denmark, England, Finland, Iceland, Scotland, Sweden, Wales Group 3 Belgium, France, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, (Germany, Israel, Spain) Group 4 Albania, Belarus, Bulgaria, Georgia, Lithuania Amsterdam

10. Key messages Significant progress made since 2005 Nearly all countries have taken a step forward: • established systematic screening • developing local to regional to national • patchy progress: • development of national guidelines • training programmes being started • regional/national implementation groups This has been led by a small/medium groups of champions in each country ~1/3 report likely to achieve 2010 targets, others part Amsterdam

11. Key messages Wide variation in prevalence • 3-5% majority • 7.9% Belgium, 6.9% Portugal, 7% Georgia • 9.0% Finland high frequency of type 1 • >10% Greece • PDR 23.5% in Czech Republic • <2% in Belarus, Bulgaria, Lithuania; <1% in Albania Expected big increase Amsterdam

12. Key messages Access to laser still poor in a few countries Problems with continued secure funding in long established programmes (Iceland) Some bizzare perverse incentives • avastin/TA being given even when laser is available Amsterdam

13. Issues identified Public awareness Patient compliance Lack of funding for equipment, training, education Collaboration between ophthalmologists and diabetologists Lack of engagement of private providers of eye care systematic process, competency, registers, data Political instability Amsterdam

14. Recommendations Group 1 • Raise awareness of diabetes and retinopathy • particularly primary care providers • also patients and public • Adequate funding for lasers and fundus cameras • (personnel not such an issue) • Establish call recall systems as the key method of the development of diabetes registers • can only be achieved by moving from local to regional to national

15. Recommendations Group 2 • For established screening programmes: • Quality improvement plan against explicit measureable standards across all components of screening and management • focus on management of screen positive cases • Comprehensive list of people with diabetes with regular maintenance • Integrate eye screening results with general diabetes care

16. Recommendations Group 3 • Develop registers of people with diabetes • consider alternative sources of data: pharmacy, pharmaceutical data, insurance data • unique identifiers • local – regional – national • Engage private eye care providers • involve health insurers in establishing systematic screening • guidelines for all professional groups should require fundus imaging at the agreed frequency • data transmission to a linked independently funded database • ensure no requirement to refer screen +ve patients

17. Recommendations Group 4 • Raise awareness of diabetes and retinopathy • particularly with patient groups • Adequate funding for lasers and fundus cameras • particularly for training programmes • Governments should fund the development and adoption of guidelines • funding can be better utilised if the frequency of screening can be reduced • Mobile screening is most relevant to rural areas

18. How can we make further progress? European Organisations Representatives: Dr. Christoph Steffen, European Commission, Information Society & Media DG Dr. Wim Wientjens, Vice President, International Diabetes Foundation Dr. Ivo Kocur, Prevention of Blindness and Deafness (PBD), World Health Organisation Dr. Karl-Jurgen Schmitt, Chairman, Structural Funds Task Force, COCIR

19. Where next? draft conference report circulated to national representatives final report circulated to key European organisations website will post abstracts and presentations next meeting in 2011 to review 2010 targets

20. Organising Committee Organising Committee Deborah Broadbent, Simon Harding, Ken Swa, Bettine Polak, Annette Moll Moderators Deborah Broadbent, Eva Kohner, Ken Swa, Simon Harding Conference Secretariat Lindy Gee, Jitta Reddingius, Ingrid van Vegde

21. Thank you