United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

Research output: Contribution to journalArticle


  • Aaron Y Lee
  • Cecilia S Lee
  • David P Crabb
  • Clare Bailey
  • Peck-Lin Lip
  • Paul Taylor
  • Maria Pikoula
  • Esther Cook
  • Toks Akerele
  • Richard Antcliff
  • Christopher Brand
  • Usha Chakravarthy
  • Randhir Chavan
  • Narendra Dhingra
  • Louise Downey
  • Haralabos Eleftheriadis
  • Faruque Ghanchi
  • Rehna Khan
  • Vineeth Kumar
  • Aires Lobo
  • Andrew Lotery
  • Geeta Menon
  • Rajarshi Mukherjee
  • Helen Palmer
  • Sudeshna Patra
  • Bobby Paul
  • Dawn A Sim
  • James Stephen Talks
  • Elizabeth Wilkinson
  • Adnan Tufail
  • Catherine A Egan

Colleges, School and Institutes

External organisations

  • University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK a.denniston@bham.ac.uk.
  • NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK.
  • 1] Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA [2] Department of Medicine, University of Washington, Seattle, Washington 98195, USA.
  • Michael J. Seckl, Imperial College London; Yenting Ngai, Stephen Nash, and Allan Hackshaw, Cancer Research UK and University College London Cancer Trials Centre; Christian H. Ottensmeier, University of Southampton and Southampton University Hospitals, Southampton; Michael Cullen, Queen Elizabeth Hospital Birmingham; Joyce Thompson, Heart of England Birmingham; Gary Middleton, University of Birmingham, Birmingham; Peter Schmid, Brighton and Sussex Medical School, Brighton; Dakshinamoorthy Muthukumar, Colchester Hospital, Colchester; Susan Harden, Cambridge University Hospital, Cambridge; Kate M. Fife, Peterborough City Hospital, Peterborough; Barbara Crosse, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield; and Paul Taylor, University Hospital South Manchester, Manchester, United Kingdom.
  • Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol
  • a Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust , Birmingham , UK.
  • Institute of Health Informatics, University College London, London, UK.
  • East Kent Hospitals University NHS Foundation Trust
  • Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK.
  • Royal United Hospital Bath NHS Trust, Royal United Hospital, Avon, Bath, Somerset, UK.
  • Department of Ophthalmology, Royal Victoria Hospital, Belfast, UK.
  • Mid Yorkshire Hospitals NHS Trust; Pinderfields Hospital; Aberford Road Wakefield West Yorkshire, WF1 4DG UK
  • Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK.
  • Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
  • Bradford Teaching Hospitals NHS Foundation Trust
  • Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
  • Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK.
  • Moorfields Eye Centre at Bedford Hospital, Bedford, UK.
  • Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
  • Frimley Park Hospital NHS Foundation Trust, Frimley, UK.
  • Leeds Teaching Hospitals NHS Trust
  • University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham
  • Royal London Hospital, Barts Health NHS Trust
  • Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
  • Moorfields Eye Centre at Croydon University Hospital, London, UK.
  • Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.
  • Northern Devon Healthcare NHS Trust, Barnstaple, UK.


AIM: To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.

METHODS: This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.

RESULTS: 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).

CONCLUSIONS: This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.


Original languageEnglish
JournalBritish Journal of Ophthalmology
Early online date29 Sep 2018
Publication statusE-pub ahead of print - 29 Sep 2018


  • diabetes, electronic medical record