Diabetes checks: delays in treatment are reduced when support staff assess eye images

NIHR | October 2021 | Diabetes checks: delays in treatment are reduced when support staff assess eye images

This NIHR Alert explains the findings of a piece of research that suggests that support staff could be trained to read images of the back of the eye (retina) almost as well as ophthalmologists. 

People living with diabetes need regular eye examinations to prevent serious problems with their vision. A shortage of eye specialists (ophthalmologists) is leading to delays in appointments. New research suggests that support staff could be trained to read images of the back of the eye (retina) almost as well as ophthalmologists. 

Most of the support staff in the study were specialist photographers who normally take images of the retina (ophthalmic photographers). The research suggests that they could be trained as ophthalmic graders and take on a new role in the NHS. They could increase capacity and reduce delays in people’s eye assessments (Source: NIHR)

The NIHR Alert can be read in full from the National Institute for Health Research


The increasing diabetes prevalence and advent of new treatments for its major visual-threatening complications (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]), which require frequent life-long follow-up, have increased hospital demands markedly. Subsequent delays in patient’s evaluation and treatment are causing sight loss. Strategies to increase capacity are needed urgently. The retinopathy (EMERALD) study tested diagnostic accuracy, acceptability, and costs of a new health care pathway for people with previously treated DME or PDR.


Prospective, multicenter, case-referent, cross-sectional, diagnostic accuracy study undertaken in 13 hospitals in the United Kingdom.


Adults with type 1 or 2 diabetes previously successfully treated DME or PDR who, at the time of enrollment, had active or inactive disease.


A new health care pathway entailing multimodal imaging (spectral-domain OCT for DME, and 7-field Early Treatment Diabetic Retinopathy Study [ETDRS] and ultra-widefield [UWF] fundus images for PDR) interpreted by trained nonmedical staff (ophthalmic graders) to detect reactivation of disease was compared with the current standard care (face-to-face examination by ophthalmologists).

Main Outcome Measures

Primary outcome: sensitivity of the new pathway. Secondary outcomes: specificity; agreement between pathways; costs; acceptability; proportions requiring subsequent ophthalmologist assessment, unable to undergo imaging, and with inadequate images or indeterminate findings.


The new pathway showed sensitivity of 97 per cent and specificity of 31 per cent to detect DME. For PDR, sensitivity and specificity using 7-field ETDRS images or UWF images, respectively) were comparable. For detection of high-risk PDR, sensitivity and specificity were higher when using UWF images, respectively, for UWF versus 80 per cent and 40 per cent , respectively, for 7-field ETDRS images). Participants preferred ophthalmologists’ assessments; in their absence, they preferred immediate feedback by graders, maintaining periodic ophthalmologist evaluations. When compared with the current standard of care, the new pathway could save £1 390 per 100 DME visits and between £461 and £1189 per 100 PDR visits.


The new pathway has acceptable sensitivity and would release resources. Users’ suggestions should guide implementation.

Evaluation of a New Model of Care for People with Complications of Diabetic Retinopathy [primary paper]

Barnsley and Rotherham: diabetic eye screening programme

Public Health England | March 2019 | Barnsley and Rotherham: diabetic eye screening programme

Public Health England (PHE) has now published an Executive summary of quality assurance (QA) visit to Barnsley and Rotherham held on 18 October 2018. 

Quality assurance (QA) visits are carried out by the Public Health England screening quality assurance service (SQAS)


The evidence for this report comes from:

  • routine monitoring of data collected by the NHS screening programmes
  • data and reports from external organisations
  • evidence submitted by the provider(s), commissioner and external organisations
  • information collected during pre-review visits
  • information shared with SQAS (North) as part of the visit process

Full details from Public Health England

Screening Quality Assurance visit report NHS Diabetic Eye Screening Programme
Barnsley and Rotherham

Diabetic eye screening: cohort management

Public Health England | February 2019 | Diabetic eye screening: cohort management

This guidance explains the management of the cohort (people on the programme register) for the NHS diabetic eye screening (DES) programme.

pexels-photo.jpgThis document explains the management of the cohort for diabetic eye screening (DES).

It includes:

  • exclusions
  • suspensions
  • people who are ineligible or off-register
  • situations that require special consideration
  • rarer forms of diabetes
    (Source: Public Health England)

Diabetic eye screening: cohort management