The English National Risk Reduction Programme for Preservation of Sight in Diabetes

Abstract

Introduction: The National Service Framework for Diabetes has set the first target that all people with diabetes in England will be screened annually for the detection of sight threatening eye disease (STED) by 2007. There is consistent evidence that screening for diabetic retinopathy is effective and treatment modalities have been established which could prevent partial sight and blindness registration in 80-90 % of cases. Methods: The Liverpool Diabetic Eye Study uses a mobile screening system utilising 35 mm, (converting to digital) 3-field fundus photography in all people with diabetes not attending an ophthalmologist. In 1995/1996 we reported detection of STED in 7.4% of cases compared to a rate of 3.7% in 2001/2002, with a sensitivity of 93% and specificity of 94%. The Policy Advisory Group has been formulated with the main aim to establish a cost effective national STED screening programme. There is currently inconsistency in service provision for diabetic retinopathy screening in the UK, ranging from organised services employing cost effective technology to ad hoc services with no central organisation. Two models of service delivery are recommended which adhere to the National Screening Committee’s requirements for a screening programme: diabetic retinopathy screening using digital mydriatic retinal photography in both community and secondary care settings with image reading by accredited individuals; diabetic retinopathy screening using indirect slit lamp mydriatic retinal biomicroscopy performed by trained personnel in both community and secondary care settings. Discussion: Increased funding for resources is required in some health authority regions in order to establish a screening programme. It is hoped that all people with diabetes will be screened for STED in order to reduce the burden of diabetic retinopathy in society