HNY Policy and Pathway Repository - Humber

Diabetic retinopathy is a chronic progressive, potentially sight-threatening disease of the retinal microvasculature associated with the prolonged hyperglycaemia and other conditions linked to diabetes mellitus such as hypertension.

Diabetic retinopathy is a disease in which the threat to sight comes through two main routes: growth of new vessels leading to intraocular haemorrhage and possible retinal detachment with profound global sight loss, and localised damage to the macula / fovea of the eye with loss of central visual acuity.

Classification and severity grading of diabetic retinopathy have historically been based on ophthalmoscopically visible signs of increasing severity, ranked into a stepwise scale from no retinopathy through various stages of non-proliferative or preproliferative disease to advanced proliferative disease. However, this grading may not accurately reflect functionally severe disease since maculopathy with severe visual loss may occur in the presence of moderate ophthalmoscopic signs.

Two different approaches to classification have emerged:
(a) those designed to cover the full range of retinopathy and aimed at the ophthalmologist that are based on the original Airlie House / EDTRS classification and
(b) those which are proposed for use in population screening

Changes to the sight can be indications of retinopathic degeneration, in most cases local opticians can assess and refer if approriate. If any form of sight loss occurs, refer directly to the Hull and East Yorkshire Eye Hospital.

Exclude Red Flag Symptoms

If any form of sight loss occurs, refer directly to the Hull and East Yorkshire Eye Hospital.

Do Not Refer

• If the patient  is under the age of 12 years old
• If the patient has gestational diabetes
• If the patient has never been diagnosed or coded as having Diabetes Mellitus

The NHS Diabetic Eye Screening Programme aims to reduce the risk of sight loss among people with diabetes by the early detection and treatment, if needed, of diabetic retinopathy (DR). Screening using digital photography is offered every year to all eligible people with diabetes aged 12 and over.  This includes those who are in remission of diabetes (Type 2) but does not include those with gestational diabetes.

• A confirmed diagnosis of Diabetes Mellitus (Type 1 and Type 2), or type 2 diabetes in remission.
• All children
• Please ensure that any additional requirements are indicated so that an appropriate venue and support for needs can be arranged.  Any changes for patient support occuring after referrals will also need to be updated to the service.
• Patients with diabetes resolved still require lifelong screening

Please see the below referral form. Complete and send by email to retinalscreening1@nhs.net
Discuss the referral with the patient and the importance of attending screening; leaflets are available in the additional information below.

Change to patient details - Diabetes retinal Screening

Diabetic Retinopathy Guidelines - Royal College of Opthalmologists (December 2012)

Diabetic Retinopathy Screening Process

NHS Diabetic Eye Screening: Consent and Cohort Management - Public Health England (June 2016)