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

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.