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Setting up screening: Practical issues

The key management steps within a DR screening service and the practical concerns to consider and address within the system.

Implementing screening and treatment for diabetic retinopathy has been shown to be effective, and cost-effective, with much of the evidence from resource-rich settings.

From a public health perspective, screening for diabetic eye disease is one of the most cost effective health procedures available. Diabetic eye disease can be prevented using existing technology and the cost will be many times less than the economic and human cost of managing blindness from diabetes. Because of this, and despite the many challenges involved in screening, it can be argued that it is crucial to channel available resources to develop innovative strategies to increase awareness of and access to screening services and treatment for DR across all countries and settings.

To prevent blindness the connections between screening and the referral pathways have to be actively managed. The English national diabetic eye screening programme (Scanlon, 2003) uses three key performance indicators to ensure the process remains on track:

Proportion of people with diabetes offered routine digital screening who attend a screening where images are captured: Acceptable target >75%
Time between routine digital screening event or digital surveillance event or slitlamp biomicroscopy event and printing of results letters to the person with diabetes, GP and relevant health professionals: Acceptable target: 85% within 3 weeks and 99% within 6 weeks
Time between screening event and first attended consultation at hospital eye services or digital surveillance. Acceptable time for urgent referrals: 80% within 6 weeks. Acceptable time for routine referrals: 70% within 13 weeks.

This video covers the key steps and practical concerns of managing a DR screening service. As you watch, consider the key practical challenges that need to be prioritised to realistically implement systematic early detection and management of DR in your setting. If systematic screening is already in place, what are its main challenges in your experience?