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Complications of Diabetes

Screening for Diabetic Retinopathy

Introduction

Diabetic retinopathy is the most common cause of blindness among people of a working age-group in the United Kingdom. Regular eye screening done on an annual basis, helps detect early retinopathy when the benefits of treatment are most. This greatly reduces the risk of blindness.

What’s new in Diabetic Eye screening in the UK?

  1. Recognition of the importance of eye screening by the Diabetes National Service Framework
  2. Establishment of a National Retinopathy screening programme
  3. National Eye Screening Committee
  4. National Audit standards for retinopathy screening

What methods are used for eye screening?

Two main methods have been used:

  1. Opthalmoscopy – where a doctor or optometrist examines your eyes using a hand held opthalmoscope
  2. Retinal photography – using a polaroid camera (printed photographs) or digital camera (photographs held on computer)

Some areas use the services of local optometrists to organise eye screening. Some of these optometrists may use retinal photography.

Why change to photography-based systems?

Using an opthalmoscope has been shown to be less ‘sensitive’ and less ‘specific’ than reading digital photographs. This means that there is more risk of missing signs of retinopathy and also a greater risk of making a mistaken diagnosis of retinopathy.

Obtaining a good view of the periphery of the retina is difficult at best using a hand held ophthalmoscope and requires a dilated pupil, a darkened room and a co-operative subject!

The most important advantage of eye photography is that a record is preserved, which may be referred to at a later date if necessary. With digital photographs these images are held on computer which allows convenient storage as well as access of large numbers of photographs.

Why the need for a National Screening programme?

The proportion of people with diabetes who are screened for retinopathy varies greatly from district to district (38% to 85%) and across General Practice surgeries (14% to 97%). A national screening programme will help to reduce variations in screening methods and interpretation of results.

What are the current recommendations?

  • Screening should be available for all people with diabetes, aged 12 years and above
  • Screening should take place locally, usually in local GP surgeries
  • Annual screening intervals are advised
  • The method used should be sensitive and specific
  • All people with sight threatening retinopathy should be referred to an ophthalmologist. Referrals for sight threatening retinopathy being made within one week.

What are the goals set by the National Service Framework for Diabetes ?

A minimum of 80% of people with diabetes are to be offered screening for the early detection diabetic retinopathy as part of a systematic programme that meets national standards by the year 2006. This figure will rise to 100% coverage of those at risk of retinopathy by end 2007.

How much do these screening programmes cost?

Eye screening by photography is not cheap; however, it has been shown to be cost effective. The cost per patient screened varies from 10 to around 20 pounds.

What happens in my area?

In the catchment area of the Suffolk Primary Care Trust, eye screening is arranged by the West Suffolk Diabetes Eye Screening Service.

For further information see the Eye Screening Service and the Eye Screening Schedule.

People who live outside this area may have other arrangements in place for eye screening. Discuss this further with your doctor or diabetes nurse.

 

Dr Nishan Wijenaike
Consultant Diabetologist
West Suffolk Diabetes Service
November 2003