The North Central London (NCL) Diabetic Eye Screening Programme (DESP) is the only provider of NHS specialist diabetic eye screening in North Central London (NCL). NCL-DESP. This service is provided by North Middlesex University Hospital NHS Trust and conducts a quality assured screening at eight locations across the five boroughs of NCL (Barnet, Camden, Enfield, Haringey and Islington.)
Eye screening is a key part of diabetes care, and all diabetic patients aged 12 years or older, should have a specialist diabetic eye screening test every year due to the risk of developing diabetic retinopathy which can severely affect their sight.
Screening can detect the condition early and before any changes to the vision are noted by the patient and where needed the patient can be referred into hospital eye services for treatment. Early treatment can prevent severe sight loss.
Diabetic retinopathy is a microvascular disease and affects the small blood vessels in the retina. In diabetic maculopathy, the central area of the retina (the macula) is affected.
Diabetic eye screening involves taking two digital photographs of the back of each eye, once a year, to detect any early changes (diabetic retinopathy) that can occur as a result of diabetes.
Conditions we treat
All people over the age of 12 years, with a diagnosis of diabetes should attend for an annual diabetic test.
Diabetic eye screening involves taking photographs of the back of your eyes, once a year, to detect any early changes (diabetic retinopathy) that can occur as a result of diabetes. If left untreated, it can get worse and cause some loss of vision, or blindness in severe cases.
Booking your appointment
All people with diabetes aged 12 and over who live in Barnet, Camden, Enfield, Haringey and Islington should ensure they attend a free diabetic eye screening test with our specialists every year.
All patients, with a diagnosis of diabetes, will be referred to this programme by their GP and once registered with us we will send you annual reminders telling you when and where your next check up is.
If you are concerned that you have been told that you have diabetes and have not heard from us, the number to call is 020 8887 2352.
If you cannot attend an appointment, please be sure to tell us well in advance so that we can rebook your it for another convenient time and to allocate your slot to another patient.
When you attend for screening, it is important that you attend on time so that we can ensure waiting rooms do not become overcrowded and social distancing can be maintained.
Please bring your usual distance glasses with. You may also like to bring sunglasses to wear to go home as everything may look very bright
It is important that you do not drive yourself to this appointment as the eye drops used during this test cause blurred vision for between two and six hours.
The clinician will take a brief medical history, undertake a vision test and administer eye drops which will take approximately half an hour to take effect. During this time you will return to the patient waiting area. You will be recalled and photographs will be taken of the back of your eyes.
You will receive the results by letter, within three weeks of your screening test and your GP will be sent the results at the same time as these are sent to you
Refer a patient
Referral methods:
list of all patients with diabetes “Read Code” are collected from all NCL GP practices using the nationally commissioned “GP2DRS” software and sent to NCL DESP every month by the GP2DRS team.
If GPs would like to refer anyone earlier, they can do so by completing the NCL Diabetic Eye Screening Programme Referral Form and email to northmid.ncldesp@nhs.net
Referral form can be found in ISL EMIS under:
ISL global documents > Diabetes Community Services > NCL Diabetic Eye Screening
For the GP2DRS system to work efficiently, GPs must inform their system supplier (e.g. EMIS Web, SystmOne, etc.) to ensure GP2DRS remains active following any IT related change or upgrade. NCL DESP will also alert GPs monthly if IT related issues occurs.
NCL GPs should update NCL DESP of any merger or closing of a practice.
Exclusions – Following patients must be excluded by GPs:
Patients who are terminally ill
Patients who are Medically Unfit
patients who are unable to sit still in front of a slit lamp
patients who need transport on stretcher
patients who need to be transferred from a wheelchair via a hoist
Patients who are bed bound and house bound
Patients with severe dementia
Etc.
Patients with Pre-existing conditions
People who will never be able to benefit from and/or receive treatment due to a pre-existing condition
Gestational diabetes
Patients with pure gestational diabetes do not seem to progress to any referable degree of diabetic retinopathy during their pregnancy and are excluded.
If a patient has gestational diabetes, but has possible pre-existing diabetes, then the patient needs to be registered by the GP as having diabetes. DESP will then add the patient to the screening programme and screen the patient according to the national guidelines. Please see the link for the NCL-DESP Gestational Guidelines for further clarity and: https://www.nhs.uk/conditions/diabetic-eye-screening/#fileid11189
Impaired Glucose Tolerance (IGT)
Patients who have a result indicating IGT (Impaired Glucose Tolerance), borderline diabetes or pre-diabetes, and impaired fasting glycaemia are excluded.
Note:
“Medically Unfit” patients must be excluded from screening by GPs completing a “Certificate Of Unsuitability” (COU), emailed to DESP. Or complete a COU when asked by DESP.
If GPs would like a patient who is excluded from screening to be seen for a retinal examination, patients can be referred to Hospitals ophthalmology department directly by the GP.
Yes, all people over the age of 12 years, with a diagnosis of diabetes should attend for an annual diabetic eye screening test.
The only exception to this would be for patients with diabetes who are already attending a hospital eye service and are under the continuing care of a “medical retina” clinic.
Yes. The invitation letter to patients will advise people to continue to see an optician for their routine sight test. The patient leaflet which is sent out with the initial invitation also reiterates that the screening test does not replace the normal eye sight test.
If you are under the care of a hospital eye service (HES) for the management or treatment of diabetic eye disease, and we are in regular receipt of your results you may not need to attend for a diabetic eye screening test.
However, if you are being seen for any other eye condition, including cataract, macular degeneration or glaucoma, it is still important that you attend for your diabetic eye screening test.
In order that we can obtain good clear images of your eye it is necessary for us to use eye drops (1% tropicamide). The drops may cause stinging but this should wear off after a few seconds, however your sight may be slightly blurry for between 2-6 hours and will affect your ability to drive.
If, after six hours, you are still experiencing pain or discomfort, you should contact your GP. At evenings or weekends, contact your local accident and emergency department.
Very rarely, the eye drops used for screening can cause a sudden rise in pressure within the eye. This only happens in people who are already at risk of developing this problem at some point in their lives. However, when it happens it needs prompt treatment in an eye unit. The symptoms of a sudden pressure rise in the eye are:
pain or severe discomfort in your eye
redness of the white of your eye
constantly blurred sight, sometimes with rainbow haloes around lights.
If you experience any of these symptoms, please attend your local accident and emergency department.
If the photographs, taken at your visit, show signs of diabetic eye disease, a second qualified person will check the photographs. If the signs are confirmed and sight threatening, an eye specialist will look at the photographs. You will then be called to a hospital eye service (HES) eye clinic.
If the signs of diabetic eye disease are present but not threatening your sight, you may need to have more photographs taken to monitor the eye changes at a shorter interval than the normal 12 months.
Occasionally, the images taken are not of high enough quality to make a decision regarding the presence or absence of any diabetic eye disease. If this is the case we will call you back for a further test using different equipment, allowing us to make a final decision. You will receive a letter telling you of the recommendation.
If you notice problems with your eyes between screening visits do not wait until your next appointment but get advice urgently or visit your local A&E hospital.
There are things that you can do to reduce your chances of developing complications:
have regular check-ups with your healthcare team – at least once a year
check that your healthcare team does a long-term check on your diabetes, such as an HbA1c test
test your blood glucose levels at home regularly
achieve and maintain a healthy body weight
keep your blood pressure and blood fats (eg cholesterol) under control
eat a healthy balanced diet
increase your level of physical activity
don't smoke.
If we identify that you have diabetic retinopathy you should discuss this with the GP who is looking after your diabetes to improve control of your blood glucose, blood pressure and cholesterol, and preferably avoid smoking.
If you have referable retinopathy identified at a screening appointment you will be referred and should attend for your hospital eye service outpatient appointment.
Women who develop diabetes during pregnancy (known as “gestational diabetes”) do not need to attend for a diabetic eye test.
Women who had a diagnosis of diabetes before they became pregnant, require screening more frequently during pregnancy, as diabetic retinopathy can develop for the first time or worsen more quickly.
Because of this, eye screening is usually carried out at the first antenatal check and again at 28 weeks of pregnancy. Some women will also be screened when their pregnancy reaches 16 to 20 weeks (particularly women who showed some signs of diabetic retinopathy on their first set of photographs).
Please remember, it is important to attend screening as soon as possible after your pregnancy has been confirmed. If you have not received diabetic eye screening during the first 13 weeks of your pregnancy, please contact us.
Pregnant ladies who may have diabetes but not diagnosed before pregnancy, and get diagnosed during pregnancy, must be registered by GPs as diabetic as soon as possible and then referred to DESP.
