This Guidance does not change what you must do under the law.

When examining a patient with diabetes you should look for ocular changes that are not related to that condition, as well as those that are.

You should ask the patient if they are being screened for retinopathy in an NHS diabetic eye screening programme. If they are, you should ask when they last had a screening. You should clarify, as far as possible, who is responsible for the overall care and clinical management of the patient.

Even if you are not responsible for providing diabetic eye screening, you should encourage the patient to attend an NHS diabetic eye screening programme and should tell them if you believe their screening is overdue.

In addition to the procedures related to the eye examination or sight test, you may select additional ones according to the patient’s clinical need. You do not need to dilate for the sole purpose of retinopathy detection where an NHS diabetic eye screening programme is in place.

If patients are in an NHS diabetic eye screening programme, recall should be the same as for patients who do not have diabetes. (This applies for patients who have 6, 12 or 24 month diabetic eye screening reviews.) Younger people and people of black and Asian ethnicities are affected by sight-threatening diabetic retinopathy more than other groups, you should use your professional judgement to determine the most appropriate sight test interval based on your patient’s clinical needs and risk factors⁹⁴. 

You should report all relevant findings to whoever is responsible for the overall care and clinical management of the patient’s condition.

In England, the NHS diabetic eye screening programme service specification no 22 is commissioned by NHS England;⁹⁵ in Wales it is the Diabetic Retinopathy Screening Service for Wales (DRSSW);⁹⁶ in Northern Ireland it is the Diabetic Retinopathy Screening Programme (DRSP);⁹⁷ and in Scotland it is the Scottish Diabetic Retinopathy Screening (DRS) collaborative.⁹⁸

If you participate in an NHS diabetic eye screening programme you should follow local protocols. 

If a patient does not intend to attend the local NHS diabetic eye screening programme, you should offer them a dilated retinal examination. This can be part of a sight test or an additional separate service.

Even if you offer a dilated retinal examination with appropriate fundus photography or imaging, you should make it clear that your service is not an alternative to the NHS diabetic eye screening programme which conforms to National Screening Committee standards.

You should not use the term ‘screening’ unless you are referring to a quality assured scheme which meets national standards.