Diabetic Eye Screening Wales Annual Statistic Report 2022-23

Key messages

Regular eye screening reduces the risk of sight loss caused by diabetic retinopathy.
Diabetic retinopathy is a common complication of diabetes that affects the ‘seeing’ part of the eye: the retina.
Retinopathy is caused when small blood vessels in the retina grow or leak. Over time, this can affect vision temporarily or permanently.
Until it gets to a late stage, most people with retinopathy do not experience any symptoms or loss of vision; they do not know they are affected.
Regular eye screening is the best way to identify if any retinopathy is present.
Early-stage retinopathy can be reversed through keeping blood sugar levels within the target range; more advanced retinopathy can be treated by eye injections or by laser.
Diabetic Eye Screening Wales offers a free NHS screening test carried out in community venues across Wales.
The screening test is not 100% accurate and treatment for diabetic retinopathy carries risks.
Taking part in diabetic eye screening is the participant’s choice.

Background

Welcome to the fifth annual statistical report published by Diabetic Eye Screening Wales (DESW), Public Health Wales. The service aims to detect diabetic retinopathy before sight loss occurs. Research evidence shows that with early identification and treatment, loss of vision can be prevented in 70 – 90% of people with sight threatening diabetic retinopathy^{^1, ².}

DESW (previously Diabetic Retinopathy Screening Service for Wales) was initially commissioned as a national service by Welsh Government in July 2002. DESW became operational in June 2003 and by 2004 was delivering a service to participants in all Health Board areas. The service was hosted by Cardiff and Vale University Health Board until April 2016 when it transferred to join the other population-based Screening Programmes delivered by Screening Division, Public Health Wales.

¹ Diabetic Retinopathy Study Research Group (1981) Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. Ophthalmology 88: 583–600.

² Early Treatment Diabetic Retinopathy Study (ETDRS) Research Group (1985) Photocoagulation for diabetic macular oedema. Early Treatment Diabetic Retinopathy Study report number 1. Archive Ophthalmology 103: 1796–806.

Summary of activity in the reported year

Throughout 2022-23 has focused on continued recovery of the Programme following the Covid-19 pandemic. Progress in securing an increasing number of venues and reductions in social distancing regulations ensured that capacity for clinic appointments grew continuously. The referral rate into the Programme also increased, having begun this year at a reduced rate (76% of 2019-20 referral numbers) it finished at a return to pre-pandemic levels.

DESW began running daily clinics in the new Public Health Wales Screening Centre in Mountain Ash (Rhos House) at the beginning of July, with the building being officially opened by the Welsh Health Minister Eluned Morgan MS on the 15 August 2022. To date, we have had very positive feedback from the participants and staff alike regarding the new screening space. The venue comprises of four clinic rooms, which are regularly utilised by DESW, Newborn Hearing, and Abdominal Aortic Aneurysm Screening Programmes. The location is ideally placed on the high street in Mountain Ash, which brings with it the benefit of enhanced accessibility with public transport stops (bus and train) in very close proximity.

As well as focusing on recovery of screening clinic appointments, DESW has undertaken transformation work with a view to developing a Future Service Model for eye screening in Wales. Project teams reviewed all aspects of the Programme and evaluated new ways of working.

Looking forward to the next screening year

This year, Welsh Government agreed a policy change, in accordance with an evidence-based decision from the UK National Screening Committee (UKNSC) that people with diabetes identified as being at low risk from diabetic retinopathy can be safely screened every two years. This is a change from the previous arrangements under which everyone with type 1 or type 2 diabetes aged 12 years or older was invited for screening annually. All UK countries’ screening programmes are in the process of implementing the same change. Recommendations were presented to and agreed by the Wales Screening Committee (WSC), with a planned roll out of the new pathway to take place in the 1st quarter of 2023/24. This new pathway will be known locally as the Low-Risk Recall Pathway (LRRP).

A DESW implementation project team will oversee and organise the required stakeholder engagement, communication methods and materials, any staff training, and the IT system upgrade, in order to bring about this change successfully.

Headline statistics

This report covers activity from April 2022 to March 2023 inclusive.

Coverage of the programme was 31.5% within 12 months (on 31 March 2023).
The uptake rate of offered screening appointments was 81.9% (on 31 March 2023).
15,490 additional referrals were received for people who were newly diagnosed with diabetes or newly registered with a GP in Wales.
84,166 individuals were invited to attend eye screening.
68,980 individuals attended eye screening clinics (including people who attended on more than one occasion).
18% of those invited did not attend a DESW eye screening appointment.
DESW reported 63,611 screening results, including 4,039 (6.35%) reported as ‘inadequate’.
DESW identified the presence of some diabetic retinopathy in 14,424 individuals (22.68% of those screened).
2,713 people (6.01% of those who received a screening result) were identified with potential sight threatening diabetic retinopathy and referred by DESW to Ophthalmology for specialist assessment.
Throughout 2022-23, screening coverage and recall waiting times were below standard, with variation in waiting times seen in different geographical areas.