Diabetic Eye Screening Services

Question 1

what are the 2 main causes of blindness in diabetes

Answer 1

Sequelae from proliferative diabetic retinopathy:
 vitreous haemorrhage
 tractional retinal
detachment (macula)
 rubeotic glaucoma

&

Diabetic maculopathy:
 oedema
 ischaemia

Question 2

list the 3 types of sequelae from proliferative diabetic retinopathy that can lead to blindness

Answer 2

vitreous haemorrhage

tractional retinal detachment (macula)

rubeotic glaucoma

Question 3

name the 2 types of diabetic maculopathy that can lead to blindness

Answer 3

oedema
&
ischaemia

Question 4

in which years did NICE recommend DR screening and what specifically for type 1 and type 2

Answer 4

2002 & 2004

Type I - by VA & digital photography after mydriasis with tropicamide

Type II - at time of diagnosis and annually

Question 5

what is the DESP’s aim and in which 3 ways is this executed

Answer 5

DESP aims to reduce the risk of sight loss amongst people with diabetes by:
◼ early detection
◼ appropriate monitoring, and
◼ effective treatment if necessary of sight threatening diabetic retinopathy

Question 6

at what age is diabetic eye screening available

Answer 6

people with diabetes aged 12 and over

Question 7

what is the role of the screener

Answer 7

person who measures visual acuity and administers dilatation drops and/ or operates a fundus camera to capture images of the patient’s retina

also explains the test procedure and obtains consent

Question 8

what is the role of the grader

Answer 8

examines the retinal images for evidence of diabetic change in the eye and assesses those images for disease against the minimum dataset

Question 9

what is the qualification to become a DESP grader and how is this done

Answer 9

level 3 diploma qualification for diabetic eye screening

evidencing work based competency to an assessor

Question 10

what 2 types of images do all diabetic retinopathy screening programmes assess for retinopathy

Answer 10

macula image
and a
disc image

Question 11

list the 4 types of graders

Answer 11

primary grader

secondary grader - for all images showing retinopathy + 10% of no DR for quality assurance

arbitration grader - if any disputes between primary and secondary grading

referral outcome grader

Question 12

list the 4 main models of screening programme

Answer 12

Fixed location screening services

Mobile screening services

Optometry-based services

Mixed services which may involve any or all of the above or other external agencies

Question 13

what action is taken for patients with ungradeable images due to media opacities such as cataract

Answer 13

can be screened in slit lamp biomicroscopy clinics

Question 14

what action is taken for patients that require more frequent review and do not require referral to the hospital eye service

Answer 14

can be seen in digital surveillance clinics

Question 15

what is the management for someone with R0 or R1 - no diabetic retinopathy or background retinopathy

Answer 15

routine diabetes care annual screening

Question 16

what is the management for someone with R2 pre-proliferative retinopathy

Answer 16

refer to hospital eye service (HES) to be seen within 13 weeks

Achievable standard: ≥95% seen by ophthalmologist in <13 weeks Acceptable standard: ≥70% seen by ophthalmologist in <13 weeks

Question 17

what is the management for someone with R3A proliferative retinopathy

Answer 17

fast track referral to HES within 6 weeks

Acceptable standard: ≥80% seen by ophthalmologist in <6 weeks

Question 18

what is the management for someone with M1 maculopathy

R1 M1
or
R2 M1

Answer 18

refer to hospital eye service to be seen within 13 weeks

Achievable standard: ≥95% seen by ophthalmologist in <13 weeks Acceptable standard: ≥70% seen by ophthalmologist in <13 weeks

Question 19

what is the management for someone with Sudden loss of vision Retinal detachment

Answer 19

Emergency referral to HES (same day)

Question 20

How frequent are the DESP KPIs reported and what type of performance grading system is it in

Answer 20

KPIs are reported quarterly

performance presented as a traffic light system

Question 21

by when should results of someones DRS be issued by

Answer 21

within 3 weeks of routine digital screening

Question 22

what is the KPI DE1

how is it calculated

what should be the Acceptable level
what should be the Achievable level

Answer 22

DE1 = uptake of routine digital screening event

The proportion of those offered a routine diabetic eye screening appointment who attend and complete a digital screening encounter/event

subjects tested / subjects offered screening x 100%

◼ Acceptable level: ≥ 75%
◼ Achievable level: ≥ 85%

Question 23

what is KPI DE2

how is it calculated

what should be the Acceptable level
what should be the Achievable level

Answer 23

DE2 = results issued within 3 weeks of routine digital screening

The proportion of subjects attending for diabetic eye screening to whom results were issued within 3 weeks of the routine digital screening encounter/event

results issued within 3 weeks / subjects attending for screening x 100%

◼ Acceptable level: ≥ 70%
◼ Achievable level: ≥ 95%

Question 24

what is KPI DE3

how is it calculated

what should be the Acceptable level

Answer 24

DE3 = timely assessment for R3A screen positive

The proportion of screen positive subjects with referred proliferative diabetic retinopathy (PDR) attending for assessment within 6 weeks of screening encounter/event from all diabetic eye screening pathways

subjects receiving consultation within 6 weeks / subjects referred for PDR x100%

◼ Acceptable level: ≥ 80.0%

Question 25

list the 5 main themes that the 13 objectives should relate to for each local programme to submit a comprehensive report with assessments against the national quality assurance standards

and how frequently should this report be submitted

Answer 25

inform/invite
coverage
maximising uptake
diagnose
intervention/treatment 

submitted annually