Eye screening service for diabetes in Wales

The Diabetic Retinopathy Screening Service for Wales was established in 1996 as the UK's first community-based eye screening programme designed to detect and treat diabetic retinopathy, a disease of the retina that affects 40% of diabetes patients and is the leading cause of blindness in the developed world.

The service has progressively extended from a local area service into a highly successful nationwide programme that now covers the whole of Wales - in 2006 over 78,000 diabetes patients were offered screening appointments.

That figure is expected to double over the next few years and was a key factor in the decision to work with Digital Healthcare to roll out the OptoMize iP digital imaging system across Wales later this year.

There is currently an estimated 150,000 diabetes sufferers in Wales (about 6% of the population) with 75% of sufferers eligible to be referred for screening appointments by their family doctors (GPs).

Patients may choose to attend screening clinics in GP surgeries, hospital outpatient departments and community health centres, where a digital photograph is taken of the back of their eyes that can detect the early signs of diabetic retinopathy.

If the disease is caught at an early stage, laser treatment can preserve a patient's sight.

Rosemarie Keigwin-Harris, service director and a member of the national screening committee, said: "We are absolutely delighted with the response to the screening service.

"By working closely with GPs, we have succeeded in registering 100% of the known diabetic population in Wales and we are now holding 22 daily screening clinics in a variety of community-based settings across the country".

The clinics are run by screening service staff who transport cameras and laptops from a central base in Fairway Court, Treforest (covering south Wales), and satellite offices in Caernarfon (covering north Wales) and Carmarthen (covering west Wales) to the clinic locations.

After screening, they transmit the retinal images via a secure internet link to grading staff in Fairway Court who review the images and can refer patients to consultant ophthalmologists if treatment or other follow-up is required.

Patient access is a key part of the service.

Keigwin-Harris explained: "We also offer patients the opportunity to change their appointments to attend a more convenient screening clinic - for some people this might be a clinic near their work rather than their home.

"Around 8000 patients per month call us to take up this offer and we regard this as a very positive sign of their engagement with the screening service and their own healthcare".

Keigwin-Harris commented on the selection of Digital Healthcare to provide the new software system for the service: "It is clear that demand for the screening service will increase significantly over the coming years, as the number of diabetes patients continues to rise.

"We feel that Digital Healthcare will provide a state of the art system that meets national screening requirements, and is robust and reliable enough to cope with ever-increasing patient numbers.

"Another important factor in our selection was Digital Healthcare's willingness to work with us to meet our particular needs.

"Our service was designed in consultation with ophthalmologists across Wales to be operated as a single, integrated, nationwide retinal grading programme.

"Digital Healthcare has taken full account of this and designed a bespoke software system that will provide effective underpinning for our nationwide Service and can also produce the data our ophthalmologists need for research purposes".

Diabetes affects 1.8 million people in the UK and that figure is expected to increase to 3m people by 2010.

Digital imaging systems provide the most accurate method of identifying diabetic retinopathy at an early stage and Digital Healthcare's software will be used by the Wales Screening Service to monitor for changes in eye condition by comparing images taken at different points in time.

It will also contain a secure electronic patient records system so that screening staff and ophthalmologists can instantly access the histories and images of patients.

The system will be fully-automated allowing staff to generate referrals to clinics straight after screening and reports on screening results for GPs and patients.

Jim Lythgow, sales and marketing director at Digital Healthcare, said: "The Wales Diabetic Retinopathy Screening Service is a major success story and a shining example of a community-based, mobile screening programme that aims to reach out to all diabetes patients to ensure equal access to treatment.

Kevin McDonnell, operations director at Digital Healthcare, said: "We are very pleased to have been chosen to provide the software systems that will be used by this pioneering service.

"We are now working with Rosemarie Keigwin-Harris and her team to progress implementation, systems testing and staff training sessions in line with plans for the roll-out of our new system later this year".

Keigwin-Harris concluded by commenting on future plans: "We intend to continue raising awareness of the vital need for diabetes patients to attend their digital screening appointments and to extend our service to reach more patients.

"We have recently purchased two purpose built mobile clinics that we will be using in rural communities and city centre locations where it is not possible for our staff to hold a screening clinic in a health centre or hospital.

"Digital Healthcare's system enables us to operate a fully mobile, laptop-based service, so they will also have a key role to play here and in other extensions of our screening service".

The Diabetic Retinopathy Service is part of the Welsh Assembly government's eye care initiative and an important element in delivering the National Service Framework for Diabetes in Wales.

The Diabetic Retinopathy Screening Service for Wales is hosted by Cardiff and Vale NHS Trust.