Screening for diabetic retinopathy - key issues

Screening

All people over the age of 12 with diabetes should have eye screening. As diabetic retinopathy symptoms can take time to appear, it is essential that people with diabetes are screened regularly. The earlier it is detected the higher the likelihood of successful treatment.

In 2001, the National Service Framework Diabetes Standards were published for England setting out a ten year programme of change to deliver care and support for people with diabetes. The Diabetes National Service Framework (NSF) set a target that by 2006, a minimum of 80 per cent of people with diabetes are to be offered screening for the early detection (and treatment if needed) of diabetic retinopathy, as part of a systematic programme that meets national standards, rising to 100 per cent coverage of those at risk of retinopathy by end of 2007. The latest Department of Health figures show that by December 2007, 85.7 per cent of people diagnosed with diabetes were offered screening for diabetic retinopathy (Department of Health 2008a).

Digital retinal screening programmes for the early detection of diabetic retinopathy have been introduced across the UK. Diabetes UK has set out current targets and progress to date for England, Northern Ireland, Scotland and Wales.

View the Diabetes UK position statement: Retinal screening.

Retinal screening programmes

A successful retinal screening programme will monitor performance against a set of quality assured standards. The National Screening Committee has agreed a set of standards against which programmes can measure their performance. These standards will help to minimise errors and make sure that healthcare professionals and organisations improve each year. Go to the National Screening Programme for Diabetic Retinopathy website.

Screening programmes should also consider the following issues:

screening tests must use digital photography (where appropriate). Specialised software must be used reducing error margins and improving the collection of more accurate data
screening staff must be trained, accredited and competent and a clinical lead and programme manager must be in place
positive screening tests must be appropriately followed up and there must be good links to both hospital and primary care
call and recall from a comprehensive managed list of those covered by the programme
administration must be managed centrally and people with diabetes must be invited to screening annually.

People with diabetes are still experiencing difficulties accessing the free NHS annual retinal screening tests. In 2007, Diabetes UK launched the ‘Your Vision’ campaign to raise awareness of the importance of retinal screening among people with diabetes. For more information visit the Diabetes UK Your Vision website.

Patient education

In 2000, a large survey reported that in 2,386 people with diabetes questioned, only 43% knew that diabetes could cause blindness, yet 60 per cent knew that it was important to control diabetes well (Gillibrand et al 2000).

Trento et al (2002) reported that patients may not have enough knowledge and appropriately developed perceptions to engage fully in retinopathy screening programmes. Attendance rates to retinopathy screening programmes can vary and reasons for this can be diverse from patient fear of mydriatic drop instillation to lack of motivation (Gillibrand et al 2001).

Therefore it is clear that the provision of high quality structured diabetes education is a vital part of any diabetes service. The Department of Health, Diabetes UK and the National Diabetes Support Team (NDST) published guidance on how structured education should be delivered to meet National Institute for Health and Clinical Excellence (NICE) guidelines. For more information, go to: How to assess structured diabetes education: An improvement toolkit for commissioners and local diabetes communities on the Department of Health website.

There are several patient education programmes running across the UK. These include:

Desmond website
Desmond (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) is a collaborative group which works together to improve opportunities for learning and support for people with diabetes and the health care professionals involved with them.

Diabetes Education Network
It is a national network of diabetes health professionals from all parts of the UK who are committed to developing and delivering structured education programmes for people with type 1 and type 2 diabetes. It provides support and information to diabetes teams who deliver local education programmes.

DafneE (Dose Adjustment For Normal Eating)
Dafne is a skills-based structured education programme in intensive insulin therapy (IIT) delivered by specially trained diabetes specialist nurses and dieticians.

X-pert Programme
The X-pert Programme is a structured patient education programme for people with diabetes that meets key criteria identified by the Department of Health and Diabetes UK to implement the NICE guidance. It is a six week professional led programme based on the theories of patient empowerment and patient activation.

For more information, go to: patient involvement.

References

Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the reference list.