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 journalArticlepeer-review


  • 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

  • Queen Elizabeth Hospital Birmingham
  • University of Washington
  • University Hospitals Bristol NHS Foundation Trust
  • Sandwell and West Birmingham Hospitals NHS Trust
  • University College London
  • East Kent Hospitals University NHS Foundation Trust
  • Hinchingbrooke Health Care NHS Trust
  • Royal United Hospitals Bath NHS Foundation Trust
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • Royal Victoria Hospital
  • Hull and East Yorkshire Hospitals NHS Foundation Trust
  • King’s College London
  • Bradford Teaching Hospitals NHS Foundation Trust
  • Calderdale and Huddersfield NHS Foundation Trust
  • Wirral University Teaching Hospital NHS Foundation Trust
  • Moorfields Eye Hospital NHS Foundation Trust, London
  • University of Southampton
  • Frimley Park Hospital NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Barts Health NHS Trust
  • Barking, Havering and Redbridge University Hospitals NHS Trust
  • Newcastle upon Tyne Hospitals NHS Foundation Trust
  • Northern Devon Healthcare NHS Trust
  • City University London
  • Mid Yorkshire Hospitals NHS Trust


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

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