Article Text

Predictors for diabetic retinopathy progression—findings from nominal group technique and Evidence review
  1. Sajjad Haider1,
  2. Salman Naveed Sadiq2,
  3. Eniya Lufumpa1,
  4. Harpreet Sihre1,
  5. Mohammad Tallouzi1,
  6. David J Moore3,
  7. Krishnarajah Nirantharakumar3,
  8. Malcolm James Price3
  1. 1University of Birmingham, Birmingham, UK
  2. 2Ophthalmology, Royal Victoria Infirmary, Newcastle, UK
  3. 3Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Sajjad Haider; SXH397{at}


Objectives Risk stratification is needed for patients referred to hospital eye services by Diabetic Eye Screening Programme UK. This requires a set of candidate predictors. The literature contains a large number of predictors. The objective of this research was to arrive at a small set of clinically important predictors for the outcome of the progression of diabetic retinopathy (DR). They need to be evidence based and readily available during the clinical consultation.

Methods and analysis Initial list of predictors was obtained from a systematic review of prediction models. We sought the clinical expert opinion using a formal qualitative study design. A series of nominal group technique meetings to shorten the list and to rank the predictors for importance by voting were held with National Health Service hospital-based clinicians involved in caring for patients with DR in the UK. We then evaluated the evidence base for the selected predictors by critically appraising the evidence.

Results The source list was presented at nominal group meetings (n=4), attended by 44 clinicians. Twenty-five predictors from the original list were ranked as important predictors and eight new predictors were proposed. Two additional predictors were retained after evidence check. Of these 35, 21 had robust supporting evidence in the literature condensed into a set of 19 predictors by categorising DR.

Conclusion We identified a set of 19 clinically meaningful predictors of DR progression that can help stratify higher-risk patients referred to hospital eye services and should be considered in the development of an individual risk stratification model.

Study design A qualitative study and evidence review.

Setting Secondary eye care centres in North East, Midlands and South of England.

  • public health
  • retina

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  • DJM, KN and MJP are joint senior authors.

  • Contributors SH was responsible for concept and design of the work, for acquisition, analysis, interpretation of data and drafting the paper. Rest of the coauthors provided support in above, revised it critically and contributed in final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.