Diabetic Eye Disease

8) Clinical Decision Making in Diabetes


8.1 Birmingham has an excellent diabetic retinopathy screening service based at Birmingham Heartlands Hospital with imaging carried out by selected, accredited optometry practices across the area.


8.2 Unfortunately the service is currently restricted to only those practices that have a contract with Heart of England Foundation Trust.


8.3 Most practitioners are conversant with the various grades of diabetic retinopathy and aware of the degrees of urgency attached to the referral of eye disease at each stage.  It will remain the duty of all optometrists to detect and report eye disease where appropriate and patients with diabetes will frequently be seen in practices that are not involved in the National Retinopathy Screening Service, between their screening appointments.


8.4 Where sight threatening retinopathy is detected by an optometrist who is not accredited for screening it is essential to determine whether the condition is already known to the patient’s GP or to an accredited screener and whether a referral to the hospital eye service has already been made.


8.5 If it appears that the patient is not aware that a referral regarding their condition has already been made they should be advised to attend their normal screening practice as soon as possible so that a digital assessment of their condition can be carried out and a routine referral initiated. 


8.6 In the case of emergencies such as a pre retinal haemorrhage or traction detachment an emergency referral to Birmingham and Midland Eye Centre should be initiated by first making telephone contact with the triage sister.


8.7 Where non referable retinopathy or no retinopathy is detected it will be sufficient to determine whether the patient has attended for screening within the past 12 months and remind them that they should attend their screening practice no later than 12 months subsequent to their last screening episode.


8.8 Accredited optometrists should be guided by the national screening strategy whenever they see a patient with diabetes.


8.9 All optometrists and their staff should remember at all times that they may well be seeing a patient that is only attending their practice for screening.  All patients should be given the opportunity to continue to have their sight tested and spectacles dispensed by their existing family optometrist.