The English National Screening Programme for diabetic retinopathy 2003–2016

Abstract

The aim of the English NHS Diabetic Eye Screening Programme is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process. In order to achieve the delivery of evidence-based, population-based screening programmes, it was recognised that certain key components were required. It is necessary to identify the eligible population in order to deliver the programme to the maximum number of people with diabetes. The programme is delivered and supported by suitably trained, competent, and qualified, clinical and non-clinical staff who participate in recognised ongoing Continuous Professional Development and Quality Assurance schemes. There is an appropriate referral route for those with screen-positive disease for ophthalmology treatment and for assessment of the retinal status in those with poor-quality images. Appropriate assessment of control of their diabetes is also important in those who are screen positive. Audit and internal and external quality assurance schemes are embedded in the service. In England, two-field mydriatic digital photographic screening is offered annually to all people with diabetes aged 12 years and over. The programme commenced in 2003 and reached population coverage across the whole of England by 2008. Increasing uptake has been achieved and the current annual uptake of the programme in 2015–16 is 82.8% when 2.59 million people with diabetes were offered screening and 2.14 million were screened. The benefit of the programme is that, in England, diabetic retinopathy/maculopathy is no longer the leading cause of certifiable blindness in the working age group.

Evidence‐based Danish guidelines for screening of diabetic retinopathy

“…Alternatively, wide-field images of at least 70°can be used (Kernt et al 2012;Rasmussen et al 2015). 3 At least two retinal images of 45°are required (centred at the macula and the optic disc) (Aldington et al 1995;Scanlon 2017). 3 At least two retinal images of 45°are required (centred at the macula and the optic disc) (Aldington et al 1995;Scanlon 2017).…”

Retinal Telemedicine

“…[10] Improved screening rates and less vision loss after implementation of telemedicine programs have also been reported. [11] Importantly, diabetic retinopathy telemedicine screening programs have been shown to be cost effective. [10, 12]…”

“…Examples of Category 2 programs include Eyecheck (Netherlands)[17] and the National Health Services (NHS) diabetic eye screening program (United Kingdom). [11]…”

“…In this program England utilizes two 45 degree fields with mydriatic photography on all individuals with diabetes aged 12 and over, while Scotland utilizes one 45 degree field obtained with staged mydriasis, with dilation only if poor quality images are obtained. [11, 20] As a result of the program, it has been suggested that nationwide screening for diabetic retinopathy has been at least partially responsible for the relegation of diabetes related certifiable blindness behind inherited retinal disorders as the most common cause of certifiable blindness amongst working age adults in England and Wales, although many other factors may contribute to such a change.…”

Screening for Diabetic Retinopathy

“…Diabetic retinopathy screening meets the World Health Organization criteria for screening programs, which stipulates the following: the condition must have not only a recognizable early or latent stage but also effective and well-accepted treatment options, and the condition must currently be (and be expected to remain) an important public health concern [5]. Of course, efforts to increase patient screening for diabetic retinopathy should accompany efforts to increase patient education regarding the disease.…”