We welcomed Nadine Rash to give a talk at the group’s second virtual meeting. Nadine is Quality Assurance Manager and Deputy Programme Manager for the East Anglia Eye Screening Service and was accompanied by her colleague Clare Gillibrand, Engagement Officer, who is responsible for contacts with Diabetes UK, doctors surgeries, events, etc.
The service is currently disrupted due to the pandemic.
When you are diagnosed with diabetes you are “Clinical coded” C10 on your medical records. East Anglia Eye Screening software interrogates databases held at GP surgeries for this code each month, and providing you have not withheld consent, are over 12 and are alive you are kept on record for screening. First screening is within 13 weeks, assuming you are fit for screening and will be physically able to attend.
Nadine then described the screening process, which consists of a series of questions to verify and update your health details, a simple eye test and, following eye drops to dilate the pupils, 2 photos are taken of each retina.
The images are then transferred to the screening centre at Bury St Edmunds. They are assessed in order of priority as determined by the photographer, and checked by 2 graders. Images can also be triaged by a Consultant Ophthalmologist. After your images have been graded the results are sent in a letter to yourself and your GP. The most likely result is “some background retinopathy” which requires no action.
Sometimes small changes in the eye may be due to less well controlled HbA1c, blood pressure or cholesterol levels and your GP will be made aware of this so that you can be called in for an assessment. The results sent to the GP may advise a hospital referral for various conditions.
Nadine showed us retinal images with different conditions. Elevated blood glucose for a while will lead to small dots on the retina; background retinopathy. These are monitored but normally no action is required.
Maculopathy shows up as small coloured dots, where small amounts of fat have leaked into the retina from behind, perhaps due to some swelling. If this is seen, more regular screening will be planned. If the dots are extensive you will be referred immediately to hospital. It may indicate diabetes which is out of control, and the patient may not even be aware of any vision issues at all.
Proliferative haemorrhaging is seen as red blotches on the retina, again indicating very poor diabetes control. It is thankfully increasingly rare. Very high blood glucose for a long time can cause both bleeding and fat leakage, and with a shortage of oxygen in the blood can lead to loss of vision. Invasive surgery can be used as a treatment.
During the pandemic eye screening services have stopped. The service would normally be seeing 35-40 patients per 8 hour day over 20 venues. More recently screening has restarted for high risk diabetic patients, such as pregnant patients and those with eye disease that requires regular monitoring. Across East Anglia the eye screening service has 120,000 diabetes patients. Currently only 7 centres are being used for the priority screening. Brownfields in Chesterton is not open, but screening has temporarily moved to Buchan Street Neighbourhood Centre in Kings Hedges. They can now only screen a maximum of 14 patients per day due to social distancing, and the PPE changing and cleaning between patients, who will be asked to wear masks.
Obviously, this is going to impact recalls for screening, and this is expected to extend from 12 to at least 18 months for the time being. As routine screening resumes, they expect to recall higher priority patients first.
In the meantime if you feel your eyes are not OK this is the recommended action. Dry eyes, infections etc. see GP. General decline in vision, blurred vision etc. call an optician or the eye screening service for advice. For emergencies there is an on-call ophthalmologist 24 hours per day.
In the future there are plans for ‘one stop shops’, which have been pioneered in some parts of the UK. The idea is the patient with diabetes visits venues just once per year, and while there has blood pressure measured, blood tests, feet checks, medication reviews, eye screening, and can also meet representatives of weight loss and stop smoking groups.
A copy of Nadine’s presentation can be downloaded here:
Mike Willis, Facilitator