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Coronavirus: diabetic eye screening programme update

In response to the coronavirus (COVID-19) outbreak, please read our advice and information before attending the service.

The NHS Choices website has lots of information about diabetic retinopathy and may be the place to go for general information on the condition. This page aims to answer questions you might have about the screening service we provide.

• Why have I been waiting longer than normal for my eye screening appointment?

  Your local diabetic eye screening service may not be able to see as many people as before the coronavirus (COVID-19) lockdown.

  This is because of the need for social distancing and personal protective equipment (PPE). More time is also required between appointments to clean equipment, waiting areas and clinic spaces.

  People at greater risk of sight loss, such as those that have never been screened, that are pregnant or that have had signs of retinopathy in the past, are now being prioritised for screening, and patients at very low risk of sight loss may have their appointment delayed.

• How do I know that I am at low risk of sight loss?

  Your risk of sight loss is determined by the level of diabetic retinopathy present at your last screen. If you attended your last screening appointment and there was no retinopathy detected, research has shown there is very little risk of you developing sight threatening disease before your next appointment.

• How long will I have to wait for my appointment?

  We aim to invite you again no more than two years after your last eye screening appointment, as research has shown that this is safe if you had no diabetic retinopathy detected at your last visit.

  If you have waited for longer than two years, please contact us.

• What do I do if I have symptoms or reduced vision in one or both of my eyes?

  If you have any sudden problems with your vision such as the appearance of floaters, reduced vision in one or both eyes, pain or bleeding to your eyes, this could be due to diabetes or another eye condition and needs to be checked. Please contact your local optician or GP for advice or attend your local eye casualty department.

• How can I make an appointment to have my eyes screened?

  If you are over the age of 12 your GP should notify the screening programme as soon as you have been diagnosed with diabetes. Those under the age of 12 do not require screening as they are not at risk of developing diabetic retinopathy.

  Once your GP has notified the screening service, the service will invite you to an appointment. If you can’t attend this appointment, you can contact the programme directly to change this on 020 7188 1979, or email gst-tr.seldesp.admin@nhs.net.

  You should be sent an appointment to attend within three months of being diagnosed or referred.

• How do I update my contact details?

  If you move home, or change GP, we should be notified automatically by your GP. However if you have not received an appointment and are due for your annual screening appointment, please contact the programme directly on 020 7188 1979, or email gst-tr.seldesp.admin@nhs.net, to ensure we have your up-to-date details.

  If you change your phone number – either home or mobile, please contact the programme directly.

  If you move home and/or change your GP so that your registered GP is not in south east London, you will no longer be invited for screening by our programme but by the programme covering your new local area. Your GP or practice nurse can provide you with the details, or you can find out how to contact the screening programme in your area.

  Please bear in mind that if you have other hospital appointments and move house, you should also update the hospital as well as us, as they will not be notified automatically.

• Do you send appointment reminders?

  If we have a mobile phone number for you, you will receive a text message reminder a few days in advance to remind you of your pending appointment. If you do not receive your text message, please tell the screener you see when you attend who can update your contact details with your current mobile phone number.

• I have my eyes screened by an optometrist/optician – do I need to attend a diabetic eye screening appointment as well?

  Yes. An eye examination by an optometrist or optician is essential to assess the general health of your eyes, but not all optometrists are accredited to carry out diabetic retinopathy screening.

  This means that they do not have the same quality assurance processes in place which all NHS diabetic eye screening programmes have. Quality assurance covers things like the type and specification of equipment, the training of staff, quality of images, and the accuracy of the staff assessing your images for changes (for example, in a screening programme a percentage of all 'normal' images are reviewed by one other member of staff, and any 'abnormal' images which show some changes are also reviewed by at least two members of staff.

  We would therefore recommend that you attend your annual diabetic eye screening appointment as well as your local optometrist.

• Does attending a diabetic eye screening appointment replace my appointments with my optometrist/optician?

  No. Your local optometrist will carry out tests for non-diabetic eye problems which we will not perform at your screening appointment, such as testing the pressure inside your eyes, and determining whether you may benefit from a pair of glasses. As we do not perform these tests, we cannot guarantee these problems will be picked up by us.

  Therefore it is advisable to continue visiting your optician on a regular basis to ensure that any non-diabetic eye problems will also be picked up earlier.

  Many diabetic patients are eligible for free NHS sight tests as well as their eye screening appointment. Find out if you are eligible for a free eye test, or speak to your local optometrist.

  You do not need to be referred to an optician by your GP or any other health professional, you can simply make an appointment if you feel you need one.

• I have my eyes examined by an eye doctor – do I need to attend a diabetic eye screening appointment as well?

  This depends on whether your eye doctor is examining your eyes for diabetic changes or not, and if they are willing and able to let the programme know the results of this. If you are seeing an eye doctor for another condition such as Glaucoma, to be on the safe side, you should also attend for your annual diabetic eye screening appointment.

  If you have already been diagnosed with diabetic changes to your eyes and are seeing an eye doctor for treatment/or monitoring and we have also sent you an appointment, please contact us on 020 7188 1979, or email gst-tr.seldesp.admin@nhs.net. It is probable that you do not need to attend for diabetic eye screening as well, but we need to know about this so we can update your details.

• I already see an eye doctor for something else outside south east London. Can you send me to that hospital if I need to be referred?

  Unfortunately not. Our programme covers the south east London area, so we can only refer to the appropriate clinics in south east London. Other eye departments will receive patients from their local eye screening programme, or they may not run the type of clinic you need to attend.

  Once you have been seen at the clinic we refer you to, you may be able to transfer to a different hospital, but our programme must make the initial referral to one of our local hospitals.

• I am housebound/unable to travel to the hospital, do you provide home visits and if not what are the options?

  Hospital transport can be provided subject to the normal eligibility criteria for people who would otherwise find it difficult to attend hospital. This applies to all our hospital sites, but not to Gracefield Gardens or our optometrist locations. If you need transport but have been sent to a site where there is none available, contact us on 020 7188 1979 or email gst-tr.seldesp.admin@nhs.net so we can move your appointment location.

  In order to have your eyes screened you will need to be able to sit upright in a chair and rest your chin on the chin rest of the screening camera. If you use a wheelchair you may need to be able to transfer from the wheelchair to a different chair that enables us position on the chin rest of the camera which enables us to take the photographs.

  If, for whatever reason, we cannot perform photography in our screening clinics, then you can have your eyes examined in the eye department instead using a different piece of equipment. If you feel you fall into this category, please contact us to discuss this further, as it will ensure that you do not attend the wrong sort of appointment for your needs.

  If you are unable to sit upright, or are the carer of a person who is unable to sit upright, please contact us. In the vast majority of situations screening is not possible, nor is an examination in the eye department available as an alternative however we would like to discuss this with the patient, their carer and their GP.

  Home visits are not offered due to the equipment that is used. If you are able to attend the hospital and can sit upright, we are able to screen you in the screening programme or examine your eyes in the eye department. If not, please contact us to discuss this.

• What can I do to prevent diabetes causing problems with my eye sight?

  First and foremost – come to your screening appointments. We are here to detect diabetic eye problems before you notice a drop in your vision, so they can be monitored and treated as soon as possible. If you wait for diabetes to affect your vision before you come to see us, then we may detect very serious problems which are much harder to treat and may be irreversible.

  Good diabetic control is essential to prevent, or minimise diabetes affecting your eye sight and potentially causing sight loss. Your GP or practice nurse is responsible to help you achieve good diabetic control, and you should discuss this with them. If you have not done so, discuss going on an education course with your GP or practice nurse, as this may help you to manage your diabetes more effectively.

• Can I still have my eyes screened if I am unable to take time off from work to attend an appointment during the day?

  If you cannot attend one of our appointments during the day, we also run Saturday clinics at a number of our locations. Alternatively, if you are usually screened by us in one of our optometrist sites in Bexley or Greenwich they may be able to see you outside of normal office hours and at weekends. Please contact the administration team on 020 7188 1979 or email gst-tr.seldesp.admin@nhs.net to discuss or arrange this.

  We regularly review our clinic times to try and provide the best care for our patients. If you have any suggestions please let us know so we can take your views on board.

• I have moved or live outside of south east London. Why are you no longer able to see me when I attend an appointment with the diabetes specialist nurse or doctor at the hospital?

  The diabetic eye screening programme for south east London is part of a national screening programme, which ensures that screening is provided to agreed quality standards across the whole of England. As with any screening programme, a key requirement is to ensure everyone is invited for screening, otherwise the programme would not be effective. Because programmes are organised locally, each one must have clear boundaries which specify their population. This means they can set up and keep an up to date register of all people with diabetes they are responsible for screening.

  For more information visit the English National Diabetic Eye Screening Programme.

• I am pregnant; do I need to have my eyes screened more regularly?

  Yes. During pregnancy, diabetes can cause changes to occur much more quickly than they might normally so we would like to see you every three months instead. You should have your eyes screened early on in your pregnancy, usually at your first antenatal appointment with the diabetes specialist nurse or doctor, and then every three months during your pregnancy. Please make sure each time you attend that the person screening your eyes knows that you are pregnant.

  If you are attending the diabetic antenatal clinic at King’s or St Thomas’ Hospital we will aim to make an appointment to see you on the same day. Usually your diabetes specialist nurse or doctor will have contacted us to book the first appointment for you, however please contact us if wish to make sure, or if we have sent you an appointment that does not coincide with your antenatal visit date.

  Currently we offer screening to all pregnant women with diabetes attending the antenatal clinics at King’s, St Thomas’ or Lewisham Hospitals regardless of where they live. However if you do not live within Bexley, Bromley, Greenwich, Lambeth, Southwark or Lewisham, you will be discharged to your local programme for annual screening following your pregnancy.

  Gestational diabetes (hyperglycaemia)

  Some women who do not have diabetes can develop hyperglycaemia (high blood sugar) during pregnancy. This is known as gestational diabetes. Pregnant women who develop gestational diabetes are not offered screening for diabetic retinopathy.

• I do not want to be screened, how can I get you to stop sending me appointments?

  You can make an informed choice to opt out of screening. Please contact the administration team on 020 7188 1979 or email gst-tr.seldesp.admin@nhs.net to discuss this. We require you to sign a form and return this to us. We also suggest you only sign the form having discussed this with your GP, and being fully aware of the consequences that delayed diagnosis of diabetic changes could have. Opting out is valid for three years, at which point we would start inviting you to screening unless you opt out again.

  We would strongly advise against opting out, as it may place you at an increased risk of diabetic eye problems and avoidable sight loss.

  If there is a particular reason or barrier which prevents you attending screening, please contact us to discuss this as we may be able to help.

• I don’t like the dilation drops. Do I have to have them?

  Dilation drops are used by our team to allow more light into your eyes and ensure we get clear photographs. If we take photographs without using drops we may find dark patches or shadows on the photos. These photos sometimes do not meet the quality standards we need to screen your eyes safely.

  Even if you do not want the drops, please do attend your screening appointment. Let us know why you do not want them, and we may be able to work around the issues. Often a brief discussion with the screener can help ease any worries you may have.

  We would always recommend that you have the eye drops administered to minimise the risk of diabetic eye changes not being detected. However, we will never force you to have the drops against your wishes, and if you decline them we will still take photographs to try and screen you.

• I have not been diagnosed with diabetes. Why have you sent me an appointment?

  Every GP practice in our catchment area of south east London sends us a list of newly diagnosed diabetic patients and existing diabetic patients who have moved into the area. This lets us keep an up-to-date record of all the diabetic patients in our area, so we can offer all of them screening.

  Sometimes, especially when you are first diagnosed with diabetes, words like 'pre-diabetic' and 'borderline' may be used by your GP or practice nurse. Also, you may not be given any diabetic medication, as some people can manage their diabetes without medication. This does not mean that you do not have diabetes, so we still want to screen you, as any diabetic patient can develop diabetic eye problems.

  We cannot provide any information or interpretation of your blood test results or diabetic status, as we invite you solely based on what your GP tells us. Therefore, if you have any queries or questions about whether you are diabetic or not, please discuss these with your GP.

• I would like to make a comment or complaint.

  We work hard to ensure that all our patients are happy with our service. However, if this is not the case we would very much like to hear about any problems.

  The first port of call is usually the screener running the clinic. Most of the time any issues are solvable by the member of staff there, and this often provides the quickest and best resolution.

  If the screener cannot help, or you do not feel comfortable discussing the problem with them, then please contact the administration team on 020 7188 1979 or email gst-tr.seldesp.admin@nhs.net. They will be able to direct the query to the most appropriate member of staff. Email addresses for the senior managers of the programme are also available on our team members' page.

  If your complaint cannot be dealt with by the team directly, you may wish to contact the Patient Advice and Liaison Service (PALS) on 020 7188 8801 or email pals@gstt.nhs.uk.

  Guy's and St Thomas' NHS Foundation Trust are responsible for the care of all the south east London diabetic eye screening programme patients, even if you are screened at a different hospital or optometrist site. Therefore, please direct any comments and complaints you wish to escalate to our PALS team, and not your local screening location.

• I have a question/concern about diabetic eye screening that is not answered on this page.

  Please phone us on 020 7188 1979 or email gst-tr.seldesp.admin@nhs.net. Your query will be received by the administration team who will help if they can, or put you through to the most appropriate person to answer your query such as a member of the clinical team or a manager.

Further information

The legacy screening portal page on the Public Health England website has more information about the safety and effectiveness of extending the screening interval for people with no retinopathy at their last appointment.