Diabetic Retinopathy in Italy: Epidemiology Data and Telemedicine Screening Programs

Stela Vujosevic, Edoardo Midena, Stela Vujosevic, Edoardo Midena

Abstract

In Italy, the number of people living with diabetes is about 3.5 million (5.5% of the population), with an increase by about 60% in the last 20 years and with 1 person out of 3 older than 65 years. The Italian Health Service system estimates that 10 billion euros is spent annually on caring for patients with diabetes, a figure that increases yearly. No national data on prevalence and incidence of legal blindness in patients with diabetes and no national registry of patients with diabetic retinopathy (DR) are currently available. However, the available epidemiological data (in several locations throughout the country) are consistent with those reported in other European countries. The use of telemedicine for the screening of DR in Italy is confined to geographically limited locations. The available data in the literature on implementation and use of telematic screening proved to be successful from patient, caregiver, and authorities point of view. This review addresses the available epidemiological data on DR and telematic screening realities in Italy and thus may help in establishing a national screening program.

Conflict of interest statement

The authors declare that there is no conflict of interests regarding the publication of this paper.

References

    1. Wild S., Roglic G., Green A., Sicree R., King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–1053. doi: 10.2337/diacare.27.5.1047.
    1. Osservatorio ARNO Diabete. Il profilo assistenziale della popolazione con diabete. Rapporto 2015; XXIII. .
    1. Associazione Medici Diabetologi. Annali AMD.
    1. Istituto Nazionale di Statistica. Annuario Statistico Italiano 2012. Rome, Italy: Istituto Nazionale di Statistica; 2012. .
    1. Associazione Medici Diabetologi. Standard Italiani per la Cura del Diabete Mellito 2016. Rome, Italy: AMD-SID; 2016. .
    1. Bonora E., Kiechl S., Willeit J., et al. Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study. Diabetes. 2004;53(7):1782–1789. doi: 10.2337/diabetes.53.7.1782.
    1. Bruno G., Runzo C., Cavallo-Perin P., et al. Incidence of type 1 and type 2 diabetes in adults aged 30–49 years: the population-based registry in the province of Turin, Italy. Diabetes Care. 2005;28(11):2613–2619. doi: 10.2337/diacare.28.11.2613.
    1. Cherubini V., Mascioli G., Carle F. L'incidenza del diabete mellito tipo 1 nell’età infantile: lo studio RIDI. Il Diabete. 2004;16:274–281.
    1. Casu A., Songini M. Diabete mellito tipo 1 nell’adulto. In Il diabete mellito in Italia—parte prima: epidemiologia. Il Diabete. 2004;16:287–294.
    1. De Berardis G., D'Ettorre A., Graziano G., et al. The burden of hospitalization related to diabetes mellitus: a population-based study. Nutrition, Metabolism and Cardiovascular Diseases. 2012;22(7):605–612. doi: 10.1016/j.numecd.2010.10.016.
    1. Disoteo O., Grimaldi F., Papini E., et al. State-of-the-art review on diabetes care in Italy. Annals of Global Health. 2015;81(6):803–813. doi: 10.1016/j.aogh.2015.12.013.
    1. Klein B. E. K. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiology. 2007;14(4):179–183. doi: 10.1080/09286580701396720.
    1. Klein R., Klein B. E. K., Moss S. E. The wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Archives of Ophthalmology. 1984;102(4):520–526. doi: 10.1001/archopht.1984.01040030398010.
    1. Klein R., Klein B. E. K., Moss S. E. The wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Archives of Ophthalmology. 1984;102(4):527–532. doi: 10.1001/archopht.1984.01040030405011.
    1. Klein R., Klein B. E. K., Moss S. E., et al. Retinal vascular abnormalities in persons with type 1 diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVIII. Ophthalmology. 2003;110(11):2118–2125. doi: 10.1016/s0161-6420(03)00863-7.
    1. Klein R., Klein B. E. K., Moss S. E., Cruickshanks K. J. The wisconsin epidemiologic study of diabetic retinopathy: XVII. The 14- year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology. 1998;105(10):1801–1815. doi: 10.1016/S0161-6420(98)91020-X.
    1. Yau J. W. Y., Rogers S. L., Kawasaki R., et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–564. doi: 10.2337/dc11-1909.
    1. Segato T., Midena E., Grigoletto F., et al. The epidemiology and prevalence of diabetic retinopathy in the Veneto region of North East Italy. Veneto Group for Diabetic Retinopathy. Diabetic Medicine. 1991;8:S11–S16. doi: 10.1111/j.1464-5491.1991.tb02149.x.
    1. Porta M., Tomalino M. G., Santoro M. G., et al. Diabetic retinopathy as a cause of blindness in the province of Turin, North-west Italy, in 1967–1991. Diabetic Medicine. 1995;12(4):355–361. doi: 10.1111/j.1464-5491.1995.tb00492.x.
    1. Nicolucci A., Scorpiglione N., Belfiglio M., et al. Patterns of care an Italian diabetic population. The Italian Study Group for the Implementation of the St Vincent Declaration, Società Italiana di Diabetologia, Associazione Medici Diabetologi. Diabetic Medicine. 1997;14(2):158–166. doi: 10.1002/(sici)1096-9136(199702)14:2<158::aid-dia319>;2-2.
    1. Porta M., Taulaigo A. V. The changing role of the endocrinologist in the care of patients with diabetic retinopathy. Endocrine. 2014;46(2):199–208. doi: 10.1007/s12020-013-0119-4.
    1. Cruciani F., Abdolrahimzadeh S., Vicari A., Amore F. M., Di Pillo S., Mazzeo L. Causes of blind certification in an Italian province and comparison with other European countries. La Clinica Terapeutica. 2010;161(1):e11–e16.
    1. Garvican L., Clowes J., Gillow T. Preservation of sight in diabetes: developing a national risk reduction programme. Diabetic Medicine. 2000;17(9):627–634. doi: 10.1046/j.1464-5491.2000.00353.x.
    1. American Diabetes Association. Diabetic retinopathy. Diabetes Care. 1998;21(1):157–159. doi: 10.2337/diacare.21.1.157.
    1. Royal College of Ophthalmologists. Guidelines for Diabetic Retinopathy. London, UK: Royal College of Ophthalmologists; 1997.
    1. Linee-guida per lo screening, la diagnostica e il trattamento della retinopatia diabetica in Italia, 2015, .
    1. McGlynn E. A., Asch S. M., Adams J., et al. The quality of health care delivered to adults in the United States. The New England Journal of Medicine. 2003;348(26):2635–2645. doi: 10.1056/nejmsa022615.
    1. Lee P. P., Feldman Z. W., Ostermann J., Brown D. S., Sloan F. A. Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases. Ophthalmology. 2003;110(10):1952–1959. doi: 10.1016/s0161-6420(03)00817-0.
    1. Pugh J. A., Jacobson J. M., Van Heuven W. A. J., et al. Screening for diabetic retinopathy: the wide-angle retinal camera. Diabetes Care. 1993;16(6):889–895. doi: 10.2337/diacare.16.6.889.
    1. Harding S. P., Broadbent D. M., Neoh C., White M. C., Vora J. Sensitivity and specificity of photography and direct ophthalmoscopy in screening for sight threatening eye disease: the Liverpool diabetic eye study. British Medical Journal. 1995;311(7013):1131–1135. doi: 10.1136/bmj.311.7013.1131.
    1. Telemedicine A. Program for diabetic retinopathy in a veterans affairs medical center—the joslin vision network eye health care model. American Journal of Ophthalmology. 2005;39:597–604.
    1. Vujosevic S., Benetti E., Massignan F., et al. Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fields. American Journal of Ophthalmology. 2009;148(1):111–118. doi: 10.1016/j.ajo.2009.02.031.
    1. British Diabetic Association. Retinal Photographic Screening for Diabetic Eye Disease. A British Diabetic Association Report. London, UK: British Diabetic Association; 1997.
    1. Porta M., Maurino M., Severini S., et al. Clinical characteristics influence screening intervals for diabetic retinopathy. Diabetologia. 2013;56(10):2147–2152. doi: 10.1007/s00125-013-2989-7.
    1. Aldington S. J., Kohner E. M., Meuer S., Klein R., Sjølie A. K. Methodology for retinal photography and assessment of diabetic retinopathy: the EURODIAB IDDM complications study. Diabetologia. 1995;38(4):437–444. doi: 10.1007/bf00410281.
    1. Kohner E. M. A protocol for screening for diabetic retinopathy in Europe. Diabetic Medicine. 1991;8(3):263–267. doi: 10.1111/j.1464-5491.1991.tb01583.x.
    1. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic colour fundus photographs—an extension of the modified Airlie House classification. ETDRS report no 10. Ophthalmology. 1991;98(5):786–806. doi: 10.1016/s0161-6420(13)38012-9.
    1. Wilkinson C. P., Ferris F. L., III, Klein R. E., et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9):1677–1682. doi: 10.1016/S0161-6420(03)00475-5.
    1. Scarpa G., Urban F., Vujosevic S., et al. The nonmydriatic fundus camera in diabetic retinopathy screening: a cost-effective study with evaluation for future large-scale application. Journal of Ophthalmology. 2016;2016:7. doi: 10.1155/2016/4625096.4625096
    1. Invernizzi A., Bevilacqua M. T., Cozzi M., et al. Diabetic retinopathy screening: the first telemedical approach in an Italian hospital. European Journal of Ophthalmology. 2016;26(4):369–374. doi: 10.5301/ejo.5000719.
    1. Taylor-Phillips S., Mistry H., Leslie R., et al. Extending the diabetic retinopathy screening interval beyond 1 year: systematic review. British Journal of Ophthalmology. 2016;100(1):105–114. doi: 10.1136/bjophthalmol-2014-305938.
    1. Ólafsdóttir E., Stefánsson E. Biennial eye screening in patients with diabetes without retinopathy: 10-year experience. British Journal of Ophthalmology. 2007;91(12):1599–1601. doi: 10.1136/bjo.2007.123810.
    1. Lund S. H., Aspelund T., Kirby P., et al. Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs. British Journal of Ophthalmology. 2016;100:683–687. doi: 10.1136/bjophthalmol-2015-307341.
    1. Javitt J. C., Aiello L. P., Chiang Y., Ferris F. L., III, Canner J. K., Greenfield S. Preventive eye care in people with diabetes is cost-saving to the federal government. Implications for health-care reform. Diabetes Care. 1994;17(8):909–917. doi: 10.2337/diacare.17.8.909.
    1. Scanlon P. H., Aldington S. J., Leal J., et al. Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening. Health Technology Assessment. 2015;19(74):1–116. doi: 10.3310/hta19740.
    1. Scotland G., McKeigue P., Philip S., et al. Modelling the cost-effectiveness of adopting risk-stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. Diabetic Medicine. 2016;33(7):886–895. doi: 10.1111/dme.13129.
    1. Agardh E., Tababat-Khani P. Adopting 3-year screening intervals for sight-threatening retinal vascular lesions in type 2 diabetic subjects without retinopathy. Diabetes Care. 2011;34(6):1318–1319. doi: 10.2337/dc10-2308.
    1. Aspelund T., Thornórisdóttir O., Olafsdottir E., et al. Individual risk assessment and information technology to optimise screening frequency for diabetic retinopathy. Diabetologia. 2011;54, article 2525 doi: 10.1007/s00125-011-2257-7.
    1. Looker H. C., Nyangoma S. O., Cromie D. T., et al. Predicted impact of extending the screening interval for diabetic retinopathy: the Scottish Diabetic Retinopathy Screening programme. Diabetologia. 2013;56(8):1716–1725. doi: 10.1007/s00125-013-2928-7.

Source: PubMed

3
Abonner