The College of Optometrists

Examining patients with diabetes mellitus

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Sub-sections

Key points

  • You should take reasonable care when examining patients with diabetes mellitus to detect ocular changes.
  • You should encourage patients to attend an NHS diabetic eye screening programme.

Principles of examining patients with diabetes mellitus (diabetes)

A131
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.
A132
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 screening. You should clarify, as far as possible, who is responsible for the overall care and clinical management of the patient. 
A133
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. 

Procedures to include in an examination in routine practice

A134
In addition to the procedures related to the routine eye examination, 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.

Recall and reporting for routine practice

A135
If patients are in an NHS diabetic eye screening programme, recall should be the same as for patients who do not have diabetes. 
A136
You should report all relevant findings to whoever is responsible for the overall care and clinical management of the patient’s condition. 

NHS diabetic eye screening programme

A137
In England the NHS diabetic eye screening programme service specification no 22 is commissioned by NHS England;56 in Wales it is the Diabetic Retinopathy Screening Service for Wales (DRSSW);57 in Northern Ireland it is the Diabetic Retinopathy Screening Programme (DRSP);58 and in Scotland it is the Scottish Diabetic Retinopathy Screening (DRS) collaborative.59
A138
If you participate in an NHS diabetic eye screening programme you should follow local protocols. 
A139
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. 
A140
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.
A141
You should not use the term ‘screening’ unless you are referring to a quality assured scheme which meets national standards. 

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