November 20, 2019
Diabetes – Retinal screening from BMJ Learning

Diabetes – Retinal screening from BMJ Learning

Retinal screening is now done with digital
photography, and all the images are stored electronically on a specific database, which
has been purely designed just for diabetic eye-screening. The databases; they encompass
absolutely everything, from a patientís demographics to when the last appointment was, to all the
pre-screening assessments and the photos, and to the grading and the image analysis
as well, so everythingís encompassed on one database.
We have retinal screeners, and theyíre the ones that, they come in and they do all the
assessments and they take the photos, and we have retinal graders, and theyíre the
ones that do the image analysis. People with diabetes; they should be screened at least
once every year. The guideline states that it should be every 12 to 15 months.
Itís patientsí responsibility, as well as their GPís responsibility, as well as the
responsibility of the programme, to make sure that patients do come along and have their
eyes checked. We do inform a GP if weíve invited a patient, or if weíve appointed
a patient and the patient fails to attend, or fails to respond to the invite, then we
do inform the GP and let them know that the patient may need a little bit more explanation
or a little bit more education, or a little bit more encouragement to understand what
their appointmentís about so they can come and attend the appointments.
There are basically four main stages of diabetic retinopathy that we do the image analysis
for. The first category is when we donít see any visible diabetic retinopathy, so these
are patients that may only have diabetes for a short time, or if theyíve had diabetes
for a little bit longer, they may be lucky enough not to have any changes in their eyes.
With these patients, where thereís nothing visible, we would do the image analysis, and
then the results would go out, and that would tell them that thereís no diabetic retinopathy
present, and weíd inform them and their GP that weíd like to see them again the following
year. Like I said, itís normally 12 to 15 months from the last appointment to the next
one. The first stage where we can actually see
any diabetic retinopathy happening in the back of the eye is called background diabetic
retinopathy. Thatís when the first signs of diabetic retinopathy start showing up.
The main signs of that are micro-aneurisms, which are tiny little swellings in the blood
vessel, and also little leaks from the blood vessels, which can be different fluids, like
blood, or lipids; little fatty fluids. Again, if these symptoms are not sight-threatening,
so theyíre not happening in the area of central vision or likely to cause any damage, then
we would notify the patient that there are some slight background changes, but we donít
need to see them again until the following year. We would also then inform the GP to
make sure that the patientís blood sugar levels and blood pressure levels are kept
at an optimal level to ensure that there are no further complications.
Some of these patients that have background diabetic retinopathy; there may also be maculopathy
noted. Thatís where these changes are in the area of central vision and may affect
the personís vision. The fluids there can lead to a bit of waterlogging on the back
of the eye, the retina, so that can cause potential oedema, which can be damaging to
the vision, and also the exudates the little lipid deposits that Iíve mentioned; they
can also cause damage there. Any patients that we see that has anything
potentially sight-threatening, any maculopathy at all, we would refer onward to a diabetic
eye specialist and an ophthalmologist at one of the acute trusts, and they would be able
to have a look at them there for further investigation and potential treatment.
Diabetic eye-screening is very important, because unfortunately once people notice that
they have changes to their vision, so their diabetic retinopathy becomes symptomatic,
then it is too late; unfortunately, maybe by then the damage will already have been
done. Itís very important for patients to have their diabetic screening done at least
once every year, to ensure that we do catch it early enough. Because if we do catch it
early enough, then we are able to treat it, and diabetes is unfortunately still the leading
cause of blindness in the working-age population.

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