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Diabetic Retinopathy Screening Services in Scotland: Recommendations for Implementation



Diabetic Retinopathy Screening: Foreword

Diabetic retinopathy is a common complication of diabetes affecting the blood vessels of the retina. It is the leading cause of blindness amongst people of working age in Scotland. However, if detected early enough laser therapy can prevent the progression of the disease and save sight for many years in most patients.

Many people with diabetes are already receiving regular screening for retinopathy but there are significant variations across the country in terms of coverage and quality. The challenge is to ensure that all people with diabetes have access to an effective, high quality screening service.

The importance of eye screening as part of high quality diabetes care was recognised by Our National Health: A plan for action, a plan for change which indicated that: "The [Scottish Diabetes] Framework will include plans to establish a national screening for diabetic retinopathy." This report represents the latest step in turning this commitment into an effective service for patients.

The Scottish approach to screening for diabetic retinopathy has been developed in a very co-ordinated and pragmatic way. First, the clinical evidence of the effectiveness of diabetic retinopathy screening was reviewed by colleagues at the Scottish Inter-collegiate Guidelines Network (SIGN) and published in SIGN 55. The next step was the publication of a Heatlh Technology Assessment on the Organisation of services for diabetic retinopathy screening by the Health Technology Board for Scotland (now part of NHS Quality Improvement Scotland). Thirdly, the Scottish Diabetes Framework highlighted eye care as one of the "first stage priorities" of diabetes and undertook to implement the recommendations of the Health Technology Assessment. Next, NHS Quality Improvement Scotland published clinical standards for diabetic retinopathy screening. And now this report sets out how improved retinopathy screening will be delivered in Scotland.

There remains much to do before a comprehensive retinopathy screening service, based on digital imaging, is in place and the objective of ensuring that this service is available to all people with diabetes by March 2006 will be challenging. Nevertheless, with clarity about information and goals now established, and significant funding being made available by the Scottish Executive to support the central costs of the service, the target for implementation is achievable.

Preventing visual impairment and blindness in diabetes is an important goal which will require the co-opeartion and support of a wide range of stakeholders including NHS Boards, health care professionals, National Services Division, NHS Quality Improvement Scotland and, crucially, people with diabetes themselves. I commend the enthusiasm and hard work of professionals and colleagues that has brought this work forward. I look forward to working with all these groups to secure the recommendations of this report.


Malcolm Chisholm MSP
Minister for Health and Community Care