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June 27, 2016

The national screening programme presents a fantastic opportunity

Dear Editor,

I read, with interest, the recent article written by Gary Culliton on diabetes care (‘National retinopathy roll-out set for 2012’, September 9, 2011, http://bit.ly/onJIdF). It is tremendous to be finally discussing the prospect of a national screening programme for diabetic retinopathy to run in tandem with screening services for other complications of diabetes, such as foot disease.

Your article also highlights, correctly, the urgent need for the development of registers of diabetes alongside the retinopathy and foot disease registers.

The appointment of a national clinical lead in diabetic retinopathy will be welcomed and they will work closely with the clinical leads in diabetes and paediatrics. Engagement with the Irish College of Ophthalmologists, which oversees training and the assessment of manpower provision, is also critical as the proposed screening programme will significantly increase the number of patients attending an already-overburdened system.

If one is to use the latest Diabetes Federation of Ireland (DFI) figures, there are 180,000 persons with diabetes in Ireland. The article stated that 10 per cent of patients with diabetes screened for diabetic retinopathy will go on to develop treatable retinopathy and maculopathy.

Even if this is an estimation of the potential extra retinal disease burden, it means that at least 18,000 persons with diabetes are going to require access to an already-overloaded, hospital-based ophthalmic service.

However, the experience of a number of pilot community-based and hospital-based diabetic retinopathy screening programmes is helpful in estimating the effects that a national screening programme may have on the current demand for ophthalmic services.

These programmes in the North Western, the North Eastern, the Mater Misericordiae University Hospital and the Royal Victoria Eye and Ear Hospital show that 20 per cent or more of screened patients require referral to an eye unit for assessment of cataract, glaucoma and macular degeneration, as well as retinopathy.

With adjustments due to referral patterns, that will lead to 27,000 to 35,000 referrals in the first year alone. Retinal disease requiring treatment will account for approximately another 4,000 patients (each requiring six to nine interactions with the hospital) in the first year. Furthermore, when the national programme is fully operational, up to 15 per cent of the total number of patients with diabetes may be attending hospital-based clinics for treatment at any one time. This patient care load must be managed correctly and to that end, co-ordination with the receiving centres is imperative.

The Irish College of Ophthalmologists believes that the expertise and manpower can be provided within Ireland to set up and maintain a national screening programme for diabetic retinopathy. Furthermore, with adequate resources the expertise would be available to assess and treat all patients with eye disease identified by the screening programme. Ideally, this assessment would be provided in both community- and hospital-based settings.

This decision to develop a diabetic retinopathy screening programme is a great opportunity to drive down the rates of preventable blindness due to diabetes, but no more than a colonoscopy treats bowel cancer, photographs don’t cure blindness.

Let us develop the entire care pathway while the opportunity presents itself.

Looking is not treating.

Ms Patricia Logan,
Irish College of Ophthalmologists.