How should I interpret the results of a retinal screening for diabetic retinopathy, and what follow-up actions are necessary based on different severi

Retinal screening for diabetic retinopathy aims for the early detection and treatment of sight-threatening retinopathy to reduce the risk of sight loss among people with diabetes ²,³,⁴,⁵. The NHS diabetic eye screening programme is offered annually to individuals with diabetes aged 12 years or over ²,³.

• Interpreting Results (Severity Levels):
  • Diabetic Retinopathy includes non-proliferative retinopathy, proliferative retinopathy, and maculopathy ¹.
  • Clinically Significant Diabetic Macular Oedema is present if there is retinal thickening at or within 500 micrometres of the fovea, hard exudation at or within 500 micrometres of the fovea with adjacent retinal thickening, or retinal thickening of 1 disc area or more within 1 disc area of the fovea ¹.
  • Centre-involving Diabetic Macular Oedema is clinically significant and involves the central subfield of the ETDRS grid ¹.
  • High-risk Proliferative Diabetic Retinopathy is characterised by neovascularisation on or within one disc diameter of the optic disc (greater than one-fourth to one-third disc area), elsewhere in the retina (greater than one-half a disc area with a preretinal or vitreous haemorrhage), or of any optic disc with a vitreous or preretinal haemorrhage ¹.
  • Resolved Macular Oedema is indicated by the presence of isolated or sparse, small, intraretinal cysts with no other features on OCT scans ¹.
• Follow-up Actions Based on Severity:
  • Routine Annual Review: This is a possible follow-up action depending on the screening findings ²,³.
  • Earlier Review: This is another possible follow-up action based on findings ²,³.
  • Referral to an Ophthalmologist: This is a potential follow-up action depending on the screening findings ²,³.
  • Urgent Ophthalmology Review: Arrange an urgent review if there is the formation of new abnormal vessels on the retina ²,³,⁴,⁵.
  • Emergency Ophthalmology Review: Arrange an emergency review if there is sudden loss of vision, rubeosis iridis (formation of abnormal blood vessels on the anterior iris), pre-retinal or vitreous haemorrhage, or retinal detachment ²,³,⁴,⁵.
  • Specific Treatment Considerations:
    • Consider macular laser treatment in addition to anti-vascular endothelial growth factor (anti-VEGF) treatment if an eye has had a suboptimal response to anti-VEGF treatment alone after the loading phase ¹. Suboptimal response for diabetic macular oedema includes reduced vision, increased oedema, or no change/increase in retinal thickness ¹.
    • Consider vitrectomy for people with proliferative diabetic retinopathy and vitreous haemorrhage that has not cleared within 3 months ¹.
    • Offer vitrectomy to people with proliferative diabetic retinopathy and macula-involving or macula-threatening retinal detachment ¹.
    • Consider vitrectomy for non-macula-involving or non-macula-threatening retinal detachment if, despite complete panretinal photocoagulation, there is active proliferative diabetic retinopathy or recurring vitreous haemorrhages related to active proliferative diabetic retinopathy or vitreomacular traction ¹.
    • Assess disease regression 2 to 3 months after the end of treatment for proliferative diabetic retinopathy ¹.
  • General Management Considerations:
    • All clinicians involved in care should discuss how good long-term diabetes management benefits vision ¹.
    • When starting diabetes treatment likely to cause a rapid, substantial drop in HbA1c, notify the person's ophthalmologist for assessment before and after treatment ¹.
    • Ophthalmologists should have access to and discuss HbA1c and blood pressure results with the person, explaining how lowering these can reduce the risk of progression ¹.
    • Decisions on ophthalmic interventions and follow-up frequency should consider the stage of diabetic retinopathy, HbA1c level, renal function, and blood pressure ¹.
    • Healthcare professionals involved in diabetes care should be informed about the severity of a person's diabetic eye disease to aid overall diabetes management decisions ¹.