The preferences of people with diabetes for diabetic retinopathy screening

With the current worldwide epidemic of diabetes [1], annual digital photographic screening services in the four nations of the UK are coming under increasing pressure. When the National Service Framework for Diabetes: Delivery Strategy was announced by the Department of Health in England in 2003, it was believed that there were approximately 1.4 million people with diabetes who would require annual screening. Returns to the Department of Health [2] in the second quarter of 2010 reported 2 379 792 people over the age of 12 years with diabetes and, by the second quarter of 2011, this had risen to 2 511 927, a rise of over 132 000 (more than 5%) in 12 months.\ud \ud \ud There has been increasing interest in the possibility of extending screening intervals in people with diabetes at low risk of progression to sight-threatening diabetic retinopathy and there are discussions in England, Scotland, Wales and Northern Ireland about the available evidence and the possible changes that might be introduced safely for people with diabetes. Early work [3–5] suggested that screening intervals could be extended on the basis of a single screening result, and more recent work [6] estimated an individual risk of developing sight-threatening retinopathy using a combination of known clinical and demographic risk factors and recent photographic screening results in order to determine an appropriate time interval for the next examination. However, the clinical information that would be required to evaluate individual risk scores may not be readily available or may be unreliable (e.g. reported duration of diabetes).\ud \ud \ud In addition, there have always been concerns about the potential for patient loss to follow-up induced by an extended hiatus between ophthalmic evaluations [7] and about whether an individual who is informed that they are at ‘low risk’ might concentrate less on the control of their diabetes