19 December 2024
The NHS will offer optical coherence tomography (OCT) scans outside of hospital as part of efforts to screen for diabetic retinopathy.
However, OT understands that it is unlikely optometrists will be involved in the OCT pathway – a decision that the AOP has labelled “disappointing.”
A statement from NHS England highlighted that around 60,000 people are expected to receive OCT scans in a community setting as part of the NHS Diabetic Eye Screening Programme.
It is anticipated that the initiative could save around 120,000 hospital appointments each year.
The OCT scans will be delivered in a range of locations, including some larger GP practices, community hospitals and mobile vans.
OT understands after contacting NHS England that it is unlikely optometrists will be contracted to deliver OCT scans through the pathway at present.
There are currently 56 diabetic eye screening services commissioned by NHS England, with six of those services subcontracting some activity to optometrists.
Activity sub-contracted to optometrists includes slit lamp biomicroscopy and routine digital screening.
The new OCT service is part of a digital surveillance pathway. OCT scans will be delivered in the community to patients who are at higher risk of diabetic retinopathy.
NHS England has highlighted that previously less than a third of diabetic eye screening services offered OCT. It is expected that all services will be offering the technology by October 2025.
NHS national director for vaccinations and screening, Steve Russell, highlighted that the technology will enable early detection and treatment of diabetic eye disease – minimising and preventing sight loss.
“It also means that thousands of appointments in traditional hospital settings could be saved, which is great news for the NHS,” he said.
Around four million people are registered with the NHS Diabetic Eye Screening Programme, with 3.3 million people having routine digital screening every one or two years.
AOP clinical and policy director, Dr Peter Hampson, highlighted that it is disappointing that optometry practices within primary care are not being utilised as part of the programme.
“We all want to make it easier for patients on the diabetic eye screening programme so there are less trips to hospital, but there is a real question over why scarce government funding is being invested in OCT when the estate already exists in 6000 practices across the UK, with well over 60% of those already having OCT," Hampson said.
"This latest initiative is, sadly, yet another example of public health decisions being made without joined up thinking or that crucial interface with primary care,” he emphasised.
Comments (11)
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hilaryandmichael13 February 2025
Optometrists involvement in this vital health screening procedure? dont think so unless our valiant crusading optical leaders lead us into the "owt for nowt" approach and do it for free.
But of course we will recoup costs incurred for this loss leader by flogging more unnecessary specs and extras that we sell over and above those we do already-Its a brave eutopian world of optometry our leaders encourage us to pursue.
No wonder our more medically qualified colleagues laugh at our attempts at "shoptoprofessionalism"
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Nicholas Rumney05 January 2025
Apart from the very very early days in Bristol (long since left the shared care scene) and a few pioneers there has been almost no involvement in diabetic eye screening by optometrists in England. Our area its unique in having 9 commissioned and funded "so-called" enhanced services (they aren't enhanced to us they feel core) but diabetes remains under the National Screening Service. Its worked phenomenally well. We see very few people losing vision due to diabetic retinopathy and I haven't seen a visual loss at first exam with a diabetic cause for over 20 years. DR has dropped in terms of cause of blindness in figures for both working and non working population so it's been hugely successful and a very rare example of where the NHS is best in class internationally. Adding OCT refines diabetic screening and given cost of delivery of the current system its the last thing we'd want to be part of when there is so much else to do in Urgent Eye Care and glaucoma. Better integration sure and better management when the DESP sees a cupped disc, cataract or old scar so they defect to us not the HES but diabetic eye screening in practice; photographic or OCT. No thanks.
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Anonymous28 December 2024
We have been de-skilled by the large stakeholders coming in and taking over the contracts. 20 years ago, most DR screening was done in primary care.
Losing the contracts has de-skilled us all.
Yes, there needs to be investment in IT and training but DR screening should be primary care optometry.
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John Gurney20 December 2024
Excellent news
Why on earth would optometry or ophthalmology need to be involved with this, this is purely technician based work not clinical.
Our job as clinicians is not " basic screening" but diagnosis , management and treatment of disease which manifests from screening protocols populations such as this
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Dave C20 December 2024
@anonymous
Not that I'm trying to turn this into a peeing contest, but my rather 'narrow view' comes from 33 years of experience across community optometry, education & regulation. I've been involved in developing enhanced pathways; some have come to fruition & thrived, some have started but failed & others have failed at the planning stage.
The current model of community optometry, which is heavily reliant on retail sales to sustain itself cannot support large scale schemes like this, because the costs are just too high.
Screening using OCT or photographs is also not an enhanced service in my book, and does not extend the skills of optometrists.
It all depends on what you want for the future of optometry. Do you want to be an eye specialist, working autonomously & managing a range of eye conditions until surgical intervention is required OR do you want to be an over-paid refractionist & button pusher at the behest of ophthalmology & retails manager?!
You also mention: "making it convenient and uncomplicated for patients".
What would be incredibly helpful for patients would be to divorce refraction from the eye examination!
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hilaryandmichael13 February 2025
these grandiose schemes invariably result in Optoms being caned to turn over even higher numbers to get even conversion rates-we are kidding no one but ourselves
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Anonymous20 December 2024
The question for me is how involved were the AOP before this decision was made? Optometry is always on the back foot. GOS fees are pitiful, domiciliary rules are archaic, all NHS workers had access to Blue Light Cards well before Optometrists. There are countless examples of the profession not being considered, but where are the discussions?
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Anonymous19 December 2024
It's mad that primary care optometry is not being contracted to perform diabetic retinopathy screening.
The screening should be done in house and managed by the optometrist - onwards referral for treatment if this is required.
Our patients would certainly prefer this. And diversifying our work-load is never a bad thing. The Achilles heel would be whether the NHS would give suitable funding to primary eye care. GOS is pitiful and needs to be scrapped.
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hilaryandmichael13 February 2025
take it from me(40years in optometry)- not a dime for extra work and the ophthalmologists in concert with our other medical " colleagues will make sure it never happens-why? guess for yourselves
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Dave C19 December 2024
I have no idea why the AOP thinks the best place for this service is community optometry. More evidence of the disconnect between the AOP &. the financial realities of community optometry practice.
Optometry practices do not have the capacity or connectivity to deliver the high volume / low cost per visit service.
‘Joined up thinking’ would be extending this pathway & integrating with wet MD service.
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David Sculfor19 December 2024
Dr Hampson doesn't appear to understand the new Digital Surveillance pathway. I doubt patients would find it convenient to have their DS photos taken by the screening service, and then have to go elsewhere to have an OCT. How would the retinopathy grader view the scans alongside fundus photos unless they had access to the manufacturer's software?
Just because it could be done in practice doesn't automatically mean that's the best place to do it.
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