Changes to diabetic retinopathy screening – by Simon O’Neill

Simon-O'Neill-Director-of-HToday (January 15) the UK’s National Screening Committee’s (NSC) is recommending that diabetic screening for people with diabetes who are at very low risk of sight loss should be reduced from once a year to once every two years – you can read about the NSC recommendations here. The interval between screening tests for people with diabetes who are at high risk of sight loss will remain yearly.

Diabetic retinopathy is one of the most common causes of blindness in the UK. Retinopathy is damage to the tiny blood vessels (capillaries) that nourish the retina, the ‘seeing’ part of the eye. This can seriously affect your vision. Retinopathy frequently has no symptoms until it is well advanced, which is why eye screening is important as it ensures early detection of the condition when it can be treated.

Diabetes UK has reviewed the current best evidence around eye screening and we are broadly supportive of this change. However, we do have concerns about how it will be implemented and are working with the NSC to make sure that retinopathy screening for people with diabetes is fit for purpose.

Firstly we want to make sure that there is high-quality grading of retinal images, vital for picking up early signs of retinal deterioration.

Secondly we are recommending that efficient processes are in place to ensure the safe identification and management of people with diabetes, and that there is an effective reminder system in place to ensure that people are reminded to attend their appointment, whether every year or every two years. We also want to ensure that people are appropriately identified if there is a problem and can receive the most appropriate treatment.

Thirdly, making sure that this change is properly communicated to people with diabetes so they understand the changes and the importance of attending eye screening – whether it is once a year or once every two years.

Finally there should also be ongoing monitoring of screening attendance, following implementation of the change in recommendations, to ensure that the number of people with diabetes attending their eye screening appointments doesn’t decrease on a population level.

As far as we know the roll-out for the new screening interval is likely to take place in a staggered way for England and Wales, but timelines have yet to be confirmed. There will need to be a change in the law to bring the new screening recommendations into effect in Scotland and we do not yet know the approach to roll-out that Northern Ireland will be adopting.

Eye screening on the high street

It is very important that everyone with diabetes attends their retinal screening appointments as advised by their healthcare professionals. Many high street opticians are now offering and advertising retinal photography. Although everyone with diabetes should have their vision and general eye health checked regularly with their optician, this retinal photography is not part of the nationally approved retinal screening process. If people with diabetes have this, it should be in addition to – not in place of – their full eye screening appointment.

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