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Systematic screening in the UK: What have we learned?

Lessons learnt on the English DR screening programme and practical reflection for programmes in low resources settings

In this video, Professor Peter Scanlon, Clinical Director for the English NHS National Diabetic Eye Screening Programme since 2002, shares his insights with Mr Effendi Hashim from Hospital Putrajaya, Malaysia. They discuss how the English programme was set up, its achievements and how the lessons learnt might be applied by programmes in low resource settings.

Below are some more details, adapted from a recent paper (Scanlon 2017), on the programme’s development, activities and impacts.

As you watch the video and read the text consider how important information systems are for providing evidence to guide the development and management of a screening programme, within a health system.

The English NHS Diabetic Eye Screening Programme

The programme aims to reduce the risk of sight loss amongst people with diabetes by prompt identification and, where necessary, effective treatment for sight-threatening diabetic retinopathy across England.

To deliver evidence-based screening the programme needed to consider 11 different stages:

  1. Manoeuvring around the politics of funding
  2. Are assessment and treatment facilities available?
  3. Identify cohort for invitation and call—recall
  4. How to invite them?
  5. Informing the patients and maximising uptake
  6. Establish an IT infrastructure
  7. Choose a camera and decide on compression levels for photographs
  8. The test
  9. The grading referral criteria and viewing of the images
  10. Employ and train a competent workforce
  11. Introduce Quality Assurance.

To get the programme established it was critical that diabetologists, ophthalmologists, public health doctors and optometrists came together and spoke with one voice.

Recent activities and impacts

By 2014, for the first time in at least five decades, diabetic retinopathy (DR)/maculopathy was no longer the leading cause of certifiable blindness amongst working age adults in England and Wales, having been overtaken by inherited retinal disorders.

In 2015 and 2016:

  • A total of 2,144,007 people with diabetes were screened
  • Uptake was 82.8%
  • New registrations were 326,587
  • 52,597 referrals were made for identifications of maculopathy or pre-proliferative DR
  • 7,593 urgent referrals were made for proliferative DR
  • Rate of DR per 100,000 people screened was 2,807.

Screening for sight-threatening diabetic retinopathy in England has been shown to be very effective in reducing blindness due to DR and in reducing the number of vitrectomy surgeries which need to be performed on advanced disease.

This article is from the free online

Diabetic Eye Disease: Building Capacity To Prevent Blindness

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