Optimisation of health services for sight threatening diabetic retinopathy in the UK

Aims: This research project aimed to investigate the future burden and risk stratification of diabetic retinopathy in the UK. Methods: The disease burden was calculated through cross-sectional studies, and its future projections through a double exponential smoothing model using primary care Data. The prediction model was designed by a systematic review of the existing models, finalising the predictors list used therein to a shorter list using nominal group technique and evidence evaluation and then a prediction model development and validation in a retrospective cohort study. Results: There is a trend of increasing prevalence of diabetes and diabetic retinopathy. This trend is highest and accelerating in Sight Threatening Diabetic Retinopathy in patients with type 1 Diabetes Mellitus. The forecast for 2030 is 1.6 million people with diabetic retinopathy and .65 million with Sight Threatening Retinopathy. The systematic review yielded 14 models and 78 predictors. A list of 19 candidate predictors was finalised. The new model has moderately good performance. Conclusion: Disease burden estimation needs to be carried out periodically to capture changing trends. External validation, clinical benefit and a nomogram are also needed. Newer imaging modalities and artificial intelligence are likely to play a part in future prognostic model research.