Diabetic maculopathy screening in England; are we seeing too much?

Purpose The England screening service classification of diabetic retinopathy has strict, quality assured criteria to identify potential diabetic maculopathy termed ‘M1’. All new M1 cases identified by the screening service are referred to a hospital service. We aimed to evaluate the effectiveness of the England National Diabetic Eye Screening R1M1 classification of diabetic maculopathy as a criteria for secondary care referral in Portsmouth, UK. Methods Retrospective audit of all patients referred to Portsmouth Hospitals NHS Trust with R1M1 pathology from April 2013 to January 2014. The total number of referrals received for this period was noted as well as the number of patients followed up in subsequent care pathways. Follow‐up data on those who remained under hospital care is presented for three years. Results A total of 306 diabetic patients were referred to Portsmouth Hospitals NHS Trust for R1M1 pathology over a 10 month period. At the first hospital appointment 135 (44%) had no fluid present on macular SD OCT and were either referred back to screening if the M1 features had resolved (65) or followed up with retinal images (70). 115 (38%) patients were considered to require further follow‐up in secondary care. Of those patients remaining in secondary care 70 remained in active follow up 3 years later. Conclusions These results would suggest that 44% of those with M1 features have no evidence of diabetic maculopathy on OCT at the initial hospital appointment and were discharged to community screening. Follow‐up for over three years in a secondary care setting is required by 23%. Secondary service could be better utilised by streamlining referrals either by refining the R1M1 classification or developing community based OCT service.