Clinical Study
Eye (2006) 20, 173–177. doi:10.1038/sj.eye.6701834; published online 28 October 2005
Ophthalmic nurse practitioner led diabetic retinopathy screening. Results of a 3-month trial
Data previously presented at the Australian Ophthalmic Nurse's Association 23rd Annual Conference. Sydney, Australia. June 2004. None of the authors has any financial interest in the contents of the manuscript
B J Kirkwood1, D J Coster1 and R W Essex1
1Flinders Medical Centre, Adelaide, Australia
Correspondence: BJ Kirkwood, Department of Ophthalmology, Flinders Medical Centre, Bedford Park SA 5042, Australia. Tel: +8 8204 4252; Fax: +8 8404 2040; E-mail: brad_kirkwood70@hotmail.com
Received 8 September 2004; Revised 2 December 2004; Accepted 12 December 2004; Published online 28 October 2005.
Abstract
Purpose
To describe the design and implementation of a nurse led diabetic retinopathy screening clinic. To present the results of a 3-month trial period assessing the concordance of retinopathy grading between a nurse practitioner and an ophthalmologist.
Method
Patients attending for annual diabetic eye review during an initial 3-month trial period were assessed in a dedicated diabetic eye clinic by an ophthalmic nurse practitioner and an ophthalmologist, with both grading the degree of diabetic retinopathy using to the Wisconsin grading system. Each was masked as to the other's findings. The concordance of retinopathy grading between ophthalmic nurse practitioner and ophthalmologist was assessed.
Results
A total of 95 patients (189 eyes) were assessed during the study period. A 92% concordance was achieved between the ophthalmologist and the ophthalmic nurse practitioner. In total, 72 eyes were graded as having some degree of retinopathy by the ophthalmologist. The sensitivity of the nurse practitioner for diagnosing the presence of diabetic retinopathy was 93%, and the specificity 91%. Nine eyes with severe nonproliferative diabetic retinopathy or worse, and four with clinically significant macular oedema were seen. All were correctly identified by the nurse practitioner.
Conclusions
The structure and management protocols of the clinic are described. An excellent concordance between ophthalmologist and nurse practitioner was achieved in this group of patients with relatively less advanced retinopathy.
Keywords:
diabetic retinopathy, nurse practitioner, Wisconsin grading system, screening, public health
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