96
VOLUME 11 NUMBER 2 • JUNE 2014
DIABETES NEWS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Correspondence to: Stephen Cook
Director Opthalmologist, The Eye Centre and East London Eye Hospital, East
London, South Africa
Tel: +27 824535987/+43 7434334
Fax: +27 43 7430359
e-mail: scook@eyecentre.co.za/steve@eyecentre.co.za
Originally published in
Diabetes Metab
2014;
5
(4): 359.
S Afr J Diabetes Vasc Dis
2014;
11
: 96
The South African diabetic retinopathy screening
programme launches
STEPHEN COOK
S
outh Africa has not had a screening programme until
recently. The Ophthalmological Society of South Africa
(OSSA) has launched a diabetic retinopathy screening pro-
gramme for South Africa. This has been administered and funded
by the African Eye Foundation.
The key component of the system is the patient-held record
titled ‘What is the score?’. This serves a combined function as a
patient information sheet for patients, their families and caregivers
and as a ‘cheat-sheet’ for healthcare practitioners to learn the
grading system. The Scottish diabetic retinopathy grading
system for screening has been chosen for use in South Africa.
This system is a simple hierachical system for grading features of
retinopathy. The system allocates grades for retinopathy (R1–4)
and maculopathy (M1–2). A key objective is to encourage access
to screening close to the point of primary care to help encourage
skills development at a local level. This is particularly important
with increased appreciation of the systemic importance of diabetic
retinopathy detection.
Systemic risk has been incorporated into the system utilising the
risk calculator developed by Prof Einar Steffanson (
. A
subsidiary site has been established at
This is
used as a counselling tool for patients and to modify the follow-up
algorithm.
An internet-basedpatient-trackingdatabasehas beenestablished
to enable common record keeping and look up by non-screening
practitioners
). This is accessed with the
patient’s consent utilising his/her database number.
A concerted effort has been made to increase access to screening
opportunities by enlisting optometrists and general practitioners.
The Scottish external quality assurance (EQA) has been utilised as a
means of establishing an accreditation process. This internet-based
system involves grading 100 fundus images. The individual sensitivity
and specificity is then plotted on a receiver operating characteristic
curve (ROC). The results are fed back to the individual with his/her
position marked in relation to the (anonymous) peer group. The
Scottish experience has been that the system encourages learning
over time and their experience shows a greater conformity over
time; 282 healthcare practitioners have completed the EQA process.
A directory has been established at
to allow patients to find accredited screening services.
The diverse range of healthcare scenarios and levels of practice
have necessitated an innovative approach to the programme. This
needs to be suited to public and private-sector needs. The system
is now ready to provide patients with access to screening. This will
enable people living with diabetes to access retinopathy screening
and to ‘know their score’ in the fight against the complications of
diabetes.
The next step will be to raise awareness regarding the need
for screening of the general public. This will be marketed on the
basis of the need for screening as a blindness-prevention strategy
and emphasising the importance of retinopathy as a biomarker for
systemic vascular complications of diabetes mellitus. Healthcare
practitioners are being educated to ‘screen for life’ as the detection
of any retinopathy is critical to inform of risk of coronary artery
disease and stroke (twice the risk). The system can be used more
generally in other countries at low cost. It is highly suited to
situations where healthcare is in evolution.
