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Diabetic Retinopathy Screening in the Avon LOC AreaNina Newsom – Avon LOC lead for DR Screening - Update November 2005. As many of you will know I have been involved with plans to improve the arrangements for DR Screening in this area since 1998 when the Pan-Avon Diabetic Retinopathy Steering Group was formed. Diabetologists, ophthalmologists, public health officials, GPs and your optometric representative met to discuss ways in which the poor provision for DR screening could be improved and produced a report detailing how a programme could be set up. Although well received the report was not acted upon due to lack of funds. The situation is now very different following publication of the National Service Framework on diabetes and guidance for DR screening programmes. Targets for the PCTs are to offer screening to 80% of those eligible by the end of March 2006 and to 100% between April 2006 and the end of December 2007 in a screening programme that meets the requirements of the National Screening Committee. Funding has been made available for the purchase of digital cameras and software. Because of the work the committee had done it was in a very good position to bid for some of these funds. Bristol, North Somerset & South Gloucestershire PCTs A letter is going out to all optometrists announcing the new screening programme. Starting in October 2005, it will offer annual screening to all 26000 people aged 12 and over with diabetes in these PCT areas. The screening will be done by a team of trained and accredited screener /graders using mobile digital cameras. They will visit local venues, often GP premises. There will be one fixed camera at Weston General Hospital. The screening programme will be run from an office at the BEH which will maintain the central database, offer annual call and recall and undertake grading and quality assurance of the digital images. People with ungradeable images will be assessed in dedicated slit lamp bio microscopy clinics. Programme manager: Verity Ellin 0117 928 3214 Banes, North Wiltshire & West Wiltshire PCTsThe existing mobile camera service will continue and be improved to meet the new standards. From January 2005 to August 2005 a pilot scheme for DR screening with optometrists using slit lamp biomicroscopy ran in North Wiltshire and West Wiltshire. Optometrists were invited to join the scheme according to their location. The spread was one optometrist for a small market town and two for the larger market towns across North Wiltshire and West Wiltshire. All the optometrists practising in these areas were invited to join and most of those who wanted to be involved did take part. To take part the optometrist had to attend an accreditation session and sign an agreement. The most contentious part of the agreement was that to stay in the scheme the optometrist agreed to purchase a camera when slit lamp bio became an unacceptable method for screening and to screen the minimum number of photographs required to meet the guidelines. The fee for taking and grading photos was never agreed. The practitioner was paid £20.00 for dilating and examining with a Volk lens, referring to an ophthalmologist where necessary. The scheme stopped when the money ran out. How will this affect us?Apart from the cameras in Banes and Weston General Hospital, the only diabetic check available in this area has been the GOS eye examination. This has been recognised by everyone (except probably the patients) as not meeting the standards expected of a DR screening programme. It is also recognised that without the goodwill of the optometrists many people would have had no screening at all and by and large we have served the population well. Unpaid diabetic retinopathy screening has been a great burden on a number of practices and many of us will be pleased to see it taken on by the new programme, provided it can cope with the numbers. Once the programme is up and running we will of course continue to provide GOS sight tests to people with diabetes. We recommend that you visit the AOP website www.assoc-optometrists.org and look at their advice under Primary Care ‘Examining the diabetic patient under the GOS’. If you would like more information www.nscretinopathy.org.uk will tell you all you ever want to know about DR screening programmes in the UK. Future involvement of optometrists Apart from assessing people with ungradeable images, which is likely to be done by hospital optometrists, there are no plans to involve optometrists in the Bristol, North Somerset and South Gloucestershire programme at this stage. Although optometrists’ practices are ideal for providing screening in many ways, particularly with regard to accessibility, problems arise with patient confidentiality, transfer of data and quality assurance. The practice database and image capture software have to be kept separate from the screening programme database and management and image capture software. There are no plans to join optometrists to the NHS net so secure transfer of images and data is a problem. To monitor the performance of optometrists a number of images have to be re-graded by an assessor. In order for enough images to be available a minimum of 250 people or 500 images per annum need to be graded by each optometrist. The more optometrists are involved the greater the number of images that need to be checked again. It is very likely that future improvements in software and data transfer will mean these problems cease to be an issue. By then the programme should be well established and if we are asked to provide an image capture service in the future, grafting us on to the programme will be a lot easier than it would be at present. I will continue to monitor the development of the programme and provide support and advice where necessary, reporting back so we all know how things are progressing. I can be contacted either through the website or on mail@newsom-davies.co.uk Nina Newsom November 2005
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