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PurposeTo estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025.MethodsA prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$.ResultsThe healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild–moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion).ConclusionsThe estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.

Aims To establish prevalence of abnormal retinal screening in children with T1DM in our hospital. To explore relationships between HbA1c and retinal screening results. Methods Retinopathy screening results in 2014–2015 were sought from regional retinal screening services for all paediatric patients older than 11.5 years with type 1 diabetes at our hospital (n = 207). HbA1c results from October 2014 to September 2015 and date of diabetes diagnosis was collected from the hospital electronic record system. Analysis was undertaken using SPSS. Differences between groups were explored using univariate analysis, with average HbA1c as the dependent variable, incorporating retinal screening result and gender as fixed factors, and duration of diabetes as a covariate. P value Results Conclusions Mean HbA1c is lower in those with normal results, compared to those with either abnormal results or no results following non-attendance. In each group there is a wide range of HbA1c, suggesting other risk factors are important for developing diabetic retinopathy. HbA1c is highest in those patients who do not attend retinal screening, suggesting these patients are at risk of undiagnosed retinopathy. Future work includes exploring barriers to accessing retinal screening to optimise attendance rates.

Improvements in delivering care for adults with diabetes in England have stalled, a report from the National Audit Office shows.1 The auditor’s previous report on diabetes services, published in 2012, showed an improvement in delivering the nine key care processes that the NHS had identified as essential for patients with diabetes.2 However, in the latest report the percentage of registered patients with diabetes who received all nine recommended care processes (except eye screening, now reported separately) remained at the same level of 60%. The report also found considerable geographical variation, as percentages ranged from 30% to 76%. The percentage of diabetes patients receiving all of the National Institute …

Background Population-based diabetes eye screening aims to reduce the occurrence of visual loss from diabetic eye disease. This study evaluated whether repeated non-attendance for diabetes eye screening is associated with risk of sight-threatening diabetic retinopathy (STDR). Methods A population-based cohort study was conducted using diabetes eye screening appointments and results bare presented for N = 35,253 patients resident in three South London boroughs invited for screening between 2008 and 2011. Analysis examined associations between the number of years in which screening was missed and risk of sight-threatening diabetic retinopathy. We also describe uptake and socio-demographic and clinical associations with non-attendance. Results There were 16,985 participants who were invited for screening in all four years, from 2008 to 2011, including 10,208 (60%) who were screened in every year, 6,564 (39%) who did not attend screening for up to three years, and 213 (1%) who did not attend screening in any year. Compared with participants who were screened annually, the adjusted relative odds of STDR were 2.28 ([95% CI 1.86, 2.78], p Conclusion Patients who do not attend diabetes eye screening are at increased risk of developing sight threatening diabetic retinopathy. This risk is greater after two years of non-attendance or when background retinopathy has already been diagnosed. Quality assurance in the screening programme should focus on repeat non-attenders who already have some evidence of retinopathy.

The prevalence of significant refractive errors and other eye diseases was measured in 2511 secondary school students aged 11-27 years in Mwanza City, Tanzania. Risk factors for myopia were explored.A questionnaire assessed the students' socioeconomic background and exposure to near work followed by visual acuity assessment and a full eye examination. Non-cycloplegic objective and subjective refraction was done on all participants with visual acuity of worse than 6/12 in either eye without an obvious cause.154 (6.1%) students had significant refractive errors. Myopia was the leading refractive error (5.6%). Amblyopia (0.4%), strabismus (0.2%), and other treatable eye disorders were uncommon. Only 30.3% of students with significant refractive errors wore spectacles before the survey. Age, sex, ethnicity, father's educational status, and a family history of siblings with spectacles were significant independent risk factors for myopia.The prevalence of uncorrected significant refractive errors is high enough to justify a regular school eye screening programme in secondary schools in Tanzania. Risk factors for myopia are similar to those reported in European, North-American, and Asian populations.

Diabetic retinopathy. A guide for diabetes care teams. By William D Alexander. Pp 62, £14.95. Oxford: Blackwell Science, 1998. ISBN 0-632-05171-X. Fear of eye disease is a major anxiety of individuals with diabetes. Monitoring the eyes of these individuals is a major anxiety of those charged with managing their diabetes. The situation is complicated by the fact that advanced diabetic retinopathy may have no effect on current visual function, but denied timely treatment it is likely to progress to irreversible visual loss. The need for efficient and reliable eye screening is …

EDITOR,--A potential source of confusion in T R Southwood's article on arthritis in children is the question of screening for chronic anterior uveitis.1 Southwood advises screening every three to six months except in low risk groups. A report published recently by a joint working party of the Royal College of …