Optical Coherence Tomography (OCT) for Diabetic Maculopathy in a Digital Surveillance Clinic the Value of OCT in Digital Surveillance within Diabetic Eye Screening

DESIGN. Retrospective Audit PURPOSE. To assess the impact of the recent introduction of OCT in one more of the digital surveillance clinics within the Birmingham, Solihull and Black Country Diabetic Eye Screening Programme. METHODS. Between April 2019 and September 2019 an audit was undertaken retrospectively of patients attending Digital Surveillance. All had M1 grading on digital photography and OCT (Heidelberg Spectralis) Images were graded as maculopathy with or without oedema. Other lesions such as age-related macular degeneration (ARMD) and epiretinal membrane (ERM) were documented. Outcomes for those with maculopathy were either referral to Hospital Eye Service (HES) or followed up in the Digital Surveillance (DS) clinic with OCT. RESULTS. 670 patients were included (M 374 F 300 U 23;mean age 60yrs). Ethnicity was not recorded reliably but was predominantly White, Afro/Caribbean, Asian. OCT images were adequate and gradable in 654 patients (97.6%). 139 (20.7%) reverted to annual recall. 433 (64%) were kept within DS. 5 (0.75%) patients were excluded as they were unsuitable for screening. 83 (12.4%) patients were referred to HES, 48 with macular oedema (mean 400μm range 319 to 625, SD 54.8) who remained in HES for treatment and review. 6 (0.9%) patients were referred to HES/GP for other eye pathology (wet ARMD/glaucoma). 4 (0.60%) patients were referred to slit-lamp because images were unassessable. CONCLUSIONS. OCT is effective in DS clinics, providing a definitive diagnosis and measure of macular oedema. This study showed that only a small proportion of patients with maculopathy needed HES referral. All referrals to HES were deemed appropriate and stayed in HES for management. Identification of false positive M1 can continue annual recall safely. OCT allows appropriate prioritising of patients needing treatment more urgently. It has helped ease the pressure in HES with major capacity issues especially during the recent Covid pandemic.