Quality improvement in the management of diabetic retinopathy and other retinal vascular disorders

The College does not currently suggest any specific outcome measures or items of supporting information which should be expected for appraisal. However, the National Ophthalmology Database includes a range of data on the treatment of patients with diabetic retinopathy which is derived from electronic patient records systems which can provide the basis for audit of local services

Although there is good evidence for the efficacy of laser treatment and anti-VEGF agents in the prevention of visual loss in diabetic retinopathy, the relationship between interventions and visual outcomes is not a simple one because it depends on many external factors such as the patient’s genetic make-up, quality of diabetic control and the presence of other co-morbidities.

For this reason, measures of quality in the care of diabetic retinopathy and other retinal vascular disorders are dominated by measures of process and relate to clinical teams or the service as a whole.

Examples of supporting information which may be included in the quality improvement section of an ophthalmologist’s portfolio include:

• Results of performance in the diabetic retinopathy grading test sets (for ophthalmologists who grade retinal screening images)
• Outcome of the most recent External Quality Assurance visit by the NHS Diabetic Eye Screening Programme (NDESP) or the equivalent programmes for Scotland, Wales and Northern Ireland, and progress against any action points identified.
• Local audits of timeliness of assessment and treatment
• Local audits of quality of clinical record keeping