Page 90 - Hospital Authority Convention 2017

Masterclasses Masterclasses
HOSPITAL AUTHORITY CONVENTION 2017

M1.1 Diabetic Eye Disease: What’s New? 10:45 Room 221

Diabetic and the Eye: An Introduction
Iu LPL
Department of Ophthalmology, Queen Mary Hospital, Hong Kong
Diabetes mellitus is one of the most common causes of visual impairment and blindness in the middle-aged and elderly. Eyes
can be affected by diabetes in the form of diabetic retinopathy, diabetic macular oedema, retinal vascular occlusion, ocular
ischaemic syndrome and cataract.

Diabetic macular oedema is characterised by accumulation of fluid and macula exudation is due to leakage from abnormal
vessels. Recent advances in technology have expanded the available investigation and treatment modalities. Optical
coherence tomography provides cross-sectional images of retina and is useful to monitor the disease progress and response
to treatment. New treatment options include intravitreal anti-vascular endothelial growth factor agents, intravitreal long-acting
steroid and subthreshold macular laser.
Proliferative diabetic retinopathy is a result of poorly controlled diabetes. It is characterised by the presence of
neovascularisation and associated with high risk of severe visual loss. Intravitreal anti-vascular endothelial growth factor
agents provide effective suppression of neovascularisation. Panretinal laser photocoagulation provides long-term control of
vascular proliferation. Surgical intervention is necessary to avoid major complications of vitreous haemorrhage and tractional
retinal detachment.
Tuesday, 16 May intervention are the keys to successful management. This talk will give an overview of how the eye is affected by diabetes and
Glycaemic control, management of co-morbidities (such as hypertension and obesity), regular eye screening and prompt

how different eye problems should be managed with illustrative case presentations.

M1.2 Diabetic Eye Disease: What’s New? 10:45 Room 221

Cost Effectiveness Analysis of the Current Screening Protocol in Detecting Diabetic Macular Edema (DME)
Wong I
Department of Ophthalmology, The University of Hong Kong, Hong Kong

Objectives
(1) To compare the sensitivity indexes of the current fundus photo-based screening strategy (Strategy A) in detecting diabetic
macular edema (DME) with three new screening strategies involving: (a) removing retinal hemorrhage on fundus photo
as a surrogate marker for maculopathy (Strategy B), or (b) adding best-corrected visual acuity (BCVA) measurement and
performing optical coherence tomography (OCT) scans on selected cases on top of the current protocol (Strategy C), or (c)
adding OCT scans for all subjects in addition to the current protocol (Strategy D). (2) To develop a cost-effective model to
identify the most cost-effective strategy.

Methodology
In this cross-sectional, observational study, subjects were screened according to the protocol set out in Strategy A, i.e. the
current fundus-photo based protocol. BCVA and OCT scans of the macula were performed on all subjects. Each subject
was simulated to undergo each of the four strategies. Should maculopathy be detected according to the specific criteria in a
particular strategy, it would be recorded and assumed to be referred. Costs of the screening, ophthalmologist consultation,
and treatment for up to 12 months were estimated. Quality-adjusted-life-years (QALYs) gained was calculated for each
specific strategy. Incremental cost-effective ratios (ICERs) were calculated with Strategy A as the benchmark. The local gross
domestic product per capita and US$50,000/QALY gained were used as references to determine cost-effectiveness.

Results
All strategies were found to be “very cost-effective”. In particular, Strategy D was found to be most cost-effective among the
four. Although it cost the most, it enabled the most QALY gained, hence the cost per QALY gained was the lowest.

Conclusion
Incorporating OCT scans of the macula for all on top of the current protocol (i.e. Strategy D) appeared to be more cost-
effective than the current protocol. This should be considered in future planning.

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