How does screening reduces the impact of conditions related to diabetes?
There is no screening programme for diabetes in England. The UK National Screening Committee (NSC) has looked at introducing population-based screening for diabetes and decided that usual care is as good as deliberately going out and screening for diabetes.
We do have a national diabetic retinopathy screening programme. It picks up retinopathy and it also picks up maculopathy. You are referred into the hospital eye service if you have either or both. The hospital eye service will treat the retinopathy and maculopathy is managed by controlling the diabetes.
The guidance relating to people with established diabetes is very much closely followed in the UK. There was a publication two or three years ago that found that diabetic retinopathy was no longer the most common reason that a working age person goes blind. That used to be the most common cause.
Are there any changes on the horizon for the diabetic retinopathy screening programme?
Various places are using a way of measuring the thickness of the macular using optical coherence tomography to filter out the people who have only got maculopathy so they can be referred back to primary care. It may be that the NSC will make that an official addition to the programme. That would reduce screened positive referrals into the hospital eye service.
A few years ago the NSC said that it would be safe to extend the screening interval for people who have neither retinopathy or maculopathy at their previous screen. Public Health England is working with the NSC to organise a safe way of ensuring that the call and recall arrangements do that properly.
What are the implications of artificial intelligence for screening?The NSC has produced a document which describes how it will assess suggestions that we use artificial intelligence. Is it as good as the current system, does it find new things and is it useful? There are proposals in two areas. One is in reading retinal images and the other is mammography. There are people actively pursuing that at the moment.
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