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Diabetic Eye Disease

Inform Diabetes retinal screening programme Eligibility Booking an appointment Screening Outcome No-urgent Referral to Hospital Eye Service  Urgent Referral to Hospital Eye Service Non-referable Retinopathy Management of Sight Threatening Diabetic Retinopathy Referral to Specialist Diabetes Service Eye Disease

Diabetic Eye disease (Diabetic  Retinopathy)

  • People with diabetes are at risk of developing eye changes known as diabetic retinopathy.

  • Diabetes can damage the blood vessels in the eye that can be damaged  

  • Damage to blood vessels in the retina may lead to bleeding or scarring in the retina

  • This can cause visual problems and even blindness.

  • Regular eye examination (usually at least annual) monitoring of retina and prompt management of retinopathy may reduce risk of visual loss

  • Eye screening should be performed or arranged at the time of diagnosis


Risk Factors:

  • Long history of diabetes

  • Poorly controlled diabetes

  • Hypertension

  • Dyslipidaemia

  • Smoking

  • Pregnancy

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Diabetes Retinal Screening Programme:

There is a national programme for diabetic retinopathy screening.  Digital photography is undertaken by trained optometrist and photographers in specific locations spread across Wolverhampton.
Wolverhampton Retinal screening programme is now part of the Birmingham, Solihull & Black Country Diabetic Eye Screening Programme which maintains a central register and invites all eligible patients for screening. 
Please inform the screening programme of all newly diagnosed/registered diabetics and/or if any individual with diabetes has not had digital eye screening.

Please email the Retinal Screening Team, Diabetes centre, New Cross Hospital, Wolverhampton WV10 0QP on rwh-tr.DESPadminteam@nhs.net
or telephone 0333 4567887

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Eligibility for screening:

The national screening committee recommends annual eye screening in all diabetics ages 12 years or above. This is a free test available for all individuals with diabetes registered with a Wolverhampton GP.
Digital screening is undertaken more frequently in pregnancy (Diabetes in Pregnancy)
Individuals with diabetes under ophthalmology care for surveillance and management of diabetic retinopathy are temporarily excluded from digital screening.
Digital retinal screening may not be appropriate for an individual with terminal illness or a bed bound patient with significant physical or mental disability. Please contact the retinal screening administration team on 01902 695325 for further advice if you feel exemption from screening is appropriate. All exclusions from screening is managed and audited by the programme.

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Screening Test Locations:

Facilities to undertake digital retinal screening are available in 13 locations spread across Wolverhampton.

All our Optometry practices have wheelchair access

Wolverhampton Diabetes
Centre
Available for individuals attending the
Diabetes Centre

Overton Eyecare
743-745 Cannock Road
The Scotlands
Wolverhampton
WV10 8PN
Telephone No: 01902 731158

Jacksons Opticians
53a Church Street,
Bilston
WV14 0AX
Telephone No: 01902 491358

Ashmore Park Opticians
54 Griffiths Drive
Ashmore Park
Wednesfield
Wolverhampton
WV11 2JW
Telephone No:
01902 739777

Flint and Partners
59 Tettenhall Road
Tettenhall
Wolverhampton
WV3 9NB
Telephone No: 01902 422096

Taylor Biddle Opticians
39 Bridgnorth Road
Compton, Wolverhampton
WV6 8AF
Telephone No: 01902 750325

Scrivens Opticians
6 - 8 Lichfield Street
Wolverhampton City Centre
WV1 1DG
Telephone No: 01902 424775

R Flatters Optometrist
35 Queen Street
Wolverhampton City Centre
WV1 3JW
Telephone No: 01902 423359

Marshoptical
Cleveland Street
Wolverhampton City Centre
WV1 3HH
Telephone No: 01902 420919

Miracle Eyes Opticians
Unit 4 Marsh Lane Parade
Fordhouses, Wolverhampton
WV10 6BA
Telephone No: 01902 789900

H W Williams
6 Trysull Road
Bradmore, Wolverhampton
WV3 7HT
Telephone No. 01902 620 352

Flint and Partners
11 Church Street
Wednesfield
Wolverhampton
WV11 1SR
Telephone No: 01902 719850

Scrivens Opticians
Market Way
Bilston, Wolverhampton
WV14 0DR
Telephone No: 01902496471

Click here for a printable version of the Screening Test Locations

For more screening locations as part of the bigger Birmingham programme please click on this link:

http://www.retinalscreening.co.uk/patient-information/

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Booking an Appointment:

If the individual with diabetes is registered in the Screening database, they will receive a letter inviting them to attend screening on an annual basis. There is a robust system of call-recall in place and individuals failing to respond to the invitation are sent at least 2 further reminder letters before the GP is informed. 

Any of the accredited optometrist practices can be contacted to book an appointment at a convenient time for digital photography. The practice should be able to offer an appointment within 4 weeks. If the individual has difficulty booking an appointment, please contact the administration team.

Screening Outcome:

All images are graded by qualified graders and double checked for quality assurance. If the images are not gradable, the individual is invited to attend the Bio-microscopy clinic for ‘slit lamp’ examination.

Outcome of the screening episode is posted to the individual and his/her GP within 4 weeks of the screening event.

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Urgent referral to the Hospital Eye Service:

Detection of proliferative diabetic retinopathy (R3) will prompt urgent referral to the medical retina specialist in the Hospital Eye Service

The system generates an automated referral letter which is dealt by the retinal screening administration team. They contact the individual by phone to book an appointment with the medical retina specialist (usually within 2 weeks of the screening event).

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Non-urgent referral to the Hospital Eye service:

Individuals with Pre-proliferative diabetic retinopathy (R2) and/or diabetic maculopathy (M1) are referred to the medical retina specialist by the retinal screening administration team. An appointment would then be offered by the hospital eye service within 12 weeks of the screening episode.

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Non-referable retinopathy:

This includes individuals with background diabetic changes in either eye and/or those with no detectable diabetic retinopathy (DR).

They require annual digital eye screening and will receive an invitation by the screening programme within 12 months from the last screening event.

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Management of Sight threatening diabetic retinopathy (STDR):

It includes proliferative diabetic retinopathy (R3), pre-proliferative retinopathy (R2) and diabetic maculopathy.

Detection of STDR prompts referral for assessment and treatment of diabetic retinopathy by medical retina specialist. All referrals to the Hospital eye service are managed by the retinal screening administration team. Individuals with STDR should be encouraged to attend the appointment offered by the Hospital Eye Service. The GP will be informed if the individual fails to attend the clinic appointment.

Management of metabolic risk factors:

Blood glucose control:
Reduction of HbA1c is beneficial in reducing the development of new and progression of existing retinopathy

Target: HbA1c value at a level below 7% is recommended if retinopathy is present provided it is safe and does not expose the individual unacceptable risk of hypoglycaemia (blood glucose control)
Caution should be exercised if high risk retinopathy is present as dramatic improvement in glycaemic control can potentially result in temporary worsening of retinopathy especially in patients with very poor glycaemic control. Laser photocoagulation is recommended before any rapid improvements in glycaemic control are achieved.

Emphasise long term benefits of good control but inform patients of the potential temporary worsening of retinopathy should diabetes control improve dramatically.

Blood Pressure control:

Reduction of blood pressure is beneficial and reduces progression of diabetic retinopathy.
Target: If retinopathy is present systolic BP should be below 130mmHg is recommended.
Refer to the guidance on Blood pressure control

Lipids:

Studies to date suggest a potential role for lipid lowering therapy in managing diabetic retinopathy, particularly in patients with extensive hard exudate deposition (diabetic maculopathy)
Target: T. Cholesterol <4, LDL < 2
Refer to the guidance on Lipid Lowering therapy

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Referral to specialist diabetes service:


Consider referral to Specialist diabetes service if metabolic risk factors remain uncontrolled in an individual with sight threatening diabetic retinopathy.

Patient information:

1. Diabetes retinopathy- the facts
2. Digital Diabetic retinopathy eye screening
3. Diabetic retinopathy screening in pregnancy
4. Diabetes UK
5. English National Diabetic Retinopathy Screening Programme

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Print Page

Click here for information regarding Wolverhampton being part of the Birmingham Retinal Screening Programme