Published:25/04/2002, Volume II2, No. 5802, Page 18

I read 'Diabetes patients denied eye checks' (news, page 8, 11 April) with interest and I am writing to offer some clarification.

The General Ophthalmic Services eye test requires an optometrist to detect the signs of 'injury, disease or abnormality in the eye'.

It is a legally defined procedure for a defined purpose and the GOS sight test should not be used for another purpose. Dilation is not a requirement of the GOS sight test, but dilated fundoscopy is essential for the identification of diabetic retinopathy.

Screening for diabetic retinopathy, therefore, should not be carried out through a GOS sight test.

All patients referred by a GP to an optometrist can, of course, receive a GOS sight test. It is at the discretion of the optometrist to decide whether to carry out procedures above and beyond the GOS sight test.

Optometrists are advised by the Association of Optometrists to refer these patients back to the GP, with a note informing the GP that a sight test has been carried out, but that the patient has not been dilated for screening purposes.

The GP should also be informed that if dilated fundoscopy has not been performed on the patient in the last year, the GP should arrange it - either by referral to a hospital service or by a community optometrist.

In the latter case, in the absence of an agreed local diabetic retinopathy screening scheme, the procedure may have to be carried out privately, for a fee, as your article said.

There are over 60-plus UK diabetic retinopathy screening schemes involving optometrists.

Primary care trusts which do not commission such a service should approach their Local Optometric Committee to discuss the introduction of a co-ordinated and properlyfunded diabetic retinopathy screening scheme, to ensure that all patients with diabetes can receive the same high standard of treatment.

The misuse of the terms 'eye test', 'eye examination' and 'eye screening' only adds to the confusion.

PCTs are advised to look at the protocol agreed between South Derbyshire health authority and South Derbyshire LOC, which sets out the contents of a GOS sight test.

Stephen Ryan Primary care manager Association of Optometrists