The publication in the spring of the national service framework for diabetes will no doubt concentrate the minds of service commissioners at primary care groups/trusts and health authorities on the need to provide diabetes services that are equitable, modern, of a high clinical standard and easily accessed by patients.
The last year has seen a number of debates, nationally and locally, about diabetic retinopathy screening services.
These debates have generally focused on the preferred modality of the service (ophthalmoscopy or photography) and the location from which the service is to be delivered.
Parallel to these debates has been a move from 35mm slide and Polaroid photography to digital fundus photography.
These debates have become confused in the minds of many, with a common assumption being that where digital cameras are the preferred modality the screening service should then be provided from a secondary care setting.
The UK national screening committee recently published its recommendations on diabetic retinopathy screening. It indicates a preference for screening to be progressively moved to digital camera systems, but also states that to ensure equity and ease of access for patients a mobile primary care-based service is likely to be the most cost-effective by delivering the optimum throughput of patients. These recommendations can be found at http: //www. diabeticretinopathy. screening. nhs. uk Any commissioners looking at proposals to develop diabetes services should look very carefully at schemes which will rely only on digital cameras sited in secondary care settings. Many optometrists already have digital cameras installed in their premises, and with the price of digital technology falling rapidly this number is set to increase significantly.
A crucial aspect of the optometrist's role is the ability to combine the roles of screener and grader in one person, thus allowing the patient to receive immediate information about their condition.
It is worthwhile noting that many audits of optometry-based diabetic retinopathy screening services are available, and have consistently demonstrated a very high quality of screening. In an NHS which is to be built on evidence-based medicine, it is disheartening to see the haste with which some commissioners and providers are making plans to disinvest in primary care optometry and move towards a digital screening system in diabetic retinopathy for which no audit data is apparently yet available.
Stephen A Ryan Primary care manager Association of Optometrists London SE1