Omen writes

Two contrasting clinical issues have hit the headlines recently, the problem in Camden and Islington with the restriction on the availability of screening for diabetic retinopathy and the perennial criticism of companies who offer domiciliary eye care services as their core business. Contrasting because one is an example of primary care eye care being moved away from optometrists prepared to provide this service to their community and the other where local practices are not prepared to offer a fundamental need to the public.

While the NHS has relied on optometrists to screen patients for diabetic retinopathy, general practitioners have happily sent patients to them and many diabetic physicians in hospitals have simply ignored eye examinations and again relied on optometry to provide the service. With the introduction of a national screening programme all this has changed. In some ways for the better as the aim is to ensure that all diabetics are screened to a common standard and in others for the worse in that optometry has been largely squeezed out of providing the service. Instead of using already skilled optometrists, primary care trusts are using technicians and mobile cameras. The issue in Camden and Islington is clearly one of resources - fundus cameras are not cheap and to spread them widely would not be cost effective. There is also the question of the number of patients seen to maintain skills but this is specious and can be dealt with by accreditation. At issue is the potential loss of patients by directing them to practices other than their regular ones. No doubt many patients will find it more convenient to have an eye exam at the same time as they are screened. It is ironic that in supporting optometry Camden and Islington have incurred the wrath of local optometrists excluded from the scheme.