The study aim is to investigate characteristics, barriers and enablers for attendance at the Diabetic Eye Screening Programme Northern Ireland (DESPNI) among people with diabetes aged 12–26 years. A mixed-methods approach with retrospective analysis and prospective, questionnaire-based data collection was completed. Data were analysed using ordinal logistic regression. A questionnaire collected information on barriers and enablers to attending DESPNI. Age, diabetes duration, attendance at diabetes clinic and lower HbA1c values were significantly associated with better attendance. Those aged 12–15 were more likely to attend screening than 16–26 years, odds ratio (OR) 4.01. Subjects diagnosed less than 5 years were more likely to attend than those with longer diabetes duration (OR = 2.52, p =< 0.001). Subjects who attended diabetes clinics were more likely to attend screening (OR = 1.89, p =< 0.001) and have a lower HbA1c (OR = 1.46, p =< 0.001). Questionnaires revealed major barriers to attendance which included inconvenient appointment times, lack of access and poor communication. While many subjects were aware of the impact of diabetes on the eye, many had little understanding of screening. This study provides pivotal information on potential barriers and enablers for young people attending eye screening. We suggest modest changes such as convenient appointment times, clearer communication and one-stop clinics could improve attendance.

Purpose: In this paper we highlight the impact which the disruption of secondary care ophthalmic services, resulting from COVID-19, has had on Sight Impairment (SI) and Severe Sight Impairment (SSI) certification in Northern Ireland. Methods: Regional data on SI and SSI certification in the period after the onset of the lockdown (19 March 2020-18 June 2020) were compared to the period immediately before lockdown (1 January 2020-18 March 2020) and to the same periods in 2019. Change documented was compared to post-lockdown reductions in primary and secondary ophthalmic care activity. Results: In 2019, during the 3-month period (19 March 2019-18 June 2019), 115 individuals were certified as sight impaired (SI 36, SSI 75, unspecified 4). Of those certified, 65 were female, 49 male. Principal causes of certification were: Age-related macular degeneration (AMD) (N = 45), glaucoma (N = 20) and diabetic eye disease (DED) (N = 10). Mean VA, recorded from the better eye of those certified, was 0.96 LogMAR. In the 3 months following the onset of lockdown (19 March 2020-18 June 2020), only 37 individuals were certified (SI 6, SSI 31), 12 female and 25 male. AMD was the most frequent cause of sight impairment (N = 20). There were only two DED certifications and one due to glaucoma. Mean VA in the better eye of those certified was 1.15LogMAR. The numbers of CVI certifications completed following the introduction of COVID-19 lockdown fell by 68%, compared to the 2019 data. There was a significant reduction in the proportion of female certifications (p = 0.01), and in certifications due to glaucoma (p = 0.02). The proportion of those certified as SSI as opposed to SI in the period after the onset of lockdown rose from 68% in 2019 to 84% in 2020. The mean VA of those certified in the period after the onset of lockdown, when compared to those certified in the other three periods, was worse by between 0.21 and 0.19 LogMAR (p = 0.06). Reductions reflected change in overall primary and secondary ophthalmic care activity. Conclusions: It is inconceivable that COVID-19 has reduced the incidence of sight-threatening eye disease. We must therefore assume that a flood of newly presenting sight loss will present once the pandemic has passed. New presentations will include those who would normally have attended during the lockdown period, and patients who, had they accessed ophthalmic care at the appropriate time, would have been saved from severe levels of blindness. The implications of the predicted increase in demand for medical, social and low vision related services are huge.

Certification and registration of those who are sight impaired (SI) provides commissioners, and the providers of health and social care support to those with vision loss, with quantifiable data on the extent of blindness and sight impairment within a community. In this article, we outline the results of a comprehensive review of certification/registration pathways and processes in Northern Ireland and highlight achievements to date. The Developing Eyecare Partnership (DEP) CVI Task Group established by the Health and Social Care Board (HSCB) reviewed all certification/registration processes, pathways and issues that may have contributed to regional under certification/registration. This was undertaken to ensure timely certification/registration of those who may benefit from being certified as either Severely Sight Impaired (SSI) or SI, and in so doing improving patient pathways and access to services. Activity included a review of all available epidemiological data collected in the 2-year periods before and after the introduction of the new pathway (January 1, 2018). This work has resulted in changes to the terminology used in relevant Northern Ireland legislation and other documentation concerning certification/registration. It has also resulted in the creation of more timely and efficient referral pathways and improvements in the quality of information available on certification and the process. Increased awareness of the certification process by health and social care professionals has resulted in a 22.5% increase in certifications over the 2-year period, before COVID-19. Certification rates are now comparable with those from other areas of the United Kingdom. The workings of the DEP CVI group, over a 5-year period, have increased awareness about SI and SSI Certification among patients and Health and Social Care Providers and have improved the quality of local epidemiological data on vision impairment. A patient-based evaluation of the new pathway is planned for 2020.

Background: Diabetes is rising globally and is the most common cause of both end-stage renal disease and blindness. People on haemodialysis have to attend several dialysis appointments per week which can affect their attendance at diabetic eye screening. In addition, previous literature suggests patients on haemodialysis are more likely to have sight threatening diabetic eye disease. This study aims to determine attendance at the Diabetic Eye Screening Programme in Northern Ireland, diabetic retinopathy severity and use of handheld retinal imaging in people with diabetes attending haemodialysis units in Northern Ireland. Methods: All patients with diabetes attending haemodialysis clinics regionally were screened and graded by the Diabetic Eye Screening Programme in Northern Ireland using a handheld and/or conventional non-mydriatic fundus camera. Results: All eligible 149 people were offered a Diabetic Eye Screening Programme in Northern Ireland appointment, 132 attended, 33.8% of whom have not been seen in >3 years and 15% had never attended Diabetic Eye Screening Programme in Northern Ireland despite multiple previous appointments. Altogether, 12.9% required urgent referral to hospital eye services which is significantly higher than the national average of 0.4%. Conclusions: Those on haemodialysis are at high risk for sight threatening diabetic retinopathy, implementing Diabetic Eye Screening Programme in Northern Ireland in haemodialysis clinics enables timely diagnosis and referral.