View from the High Street: Key role in diabetes screening
Judy Lea laments the loss of diabetic screening in practice
Author: Judy Lea
Ever since we opened our practice in 2003, we have offered diabetic screening to our patients. The quality and level of screening offered has improved over time. Initially we performed a dilated volk examination, reporting on a carbon paper form. With the advancement of retinal photography, this evolved into dilated fundus photography.
The images were downloaded onto an encrypted memory stick and couriered off to be graded and returned the following week with any messages. With the emergence of the City and Guilds diabetic screening and grading course, I became a qualified grader, so that I could grade the images. And as technology advanced, we could end the hassle of memory sticks and send everything electronically.
I was often asked why we offered it. It wasn’t compulsory, it required ongoing training and many hours set aside to grade uninterrupted. Often clinics were filled with pure diabetic checks, which didn’t necessarily cover the costs on the day and the practice could feel hectic due to the number of family members accompanying our patients.
However, with the advent of new training and qualifications, I could train colleagues to be involved more clinically as diabetic screeners, thus offering diabetic-screening-only clinics and giving colleagues personal development through the City and Guilds courses.
While I enjoyed the personal challenge and development — I have recently gone on to become a CAVA assessor for the new diabetic qualification — my main reason was to offer patients who came to us for spectacles a full clinical service in one place. Optometry makes its money from spectacle sales, I know, but I have never felt it professional to turn patients away when we could offer them something ourselves. I did my degree to become part of a healthcare profession, so it seems logical to offer as much healthcare in practice as I can.
In the 15 years we have been open, our business has grown from strength to strength as a result of offering services like diabetic screening and the positive word of mouth and the loyalty it generates.
One example was the patient brought by his wife for routine diabetic screening. As the drops dilated his eyes, she exclaimed that she never knew how large and professional we were. She left having booked herself and both sets of elderly parents in for eye examinations, all of whom were well overdue.
Indeed, we found her father to have such advanced cataracts that he was down to 6/36 in both eyes. We referred him for cataract surgery, which gave him a new lease of life. The family still visit regularly, not just for diabetic screening, but for all their spectacle and eye health needs.
Then there was the lady in her 60s, diabetic but in denial and adamant that she didn’t need to attend for screening as she was the sole carer for her grandchildren and did not have the time (or maybe didn’t like having the drops?). She came in for an eye examination as she was desperate for spectacles, the grandchildren having broken her last pair.
During the examination I could see pre-proliferative diabetic retinopathy in both eyes. After a long discussion about what she stood to gain and lose, she agreed to have the screening there and then and was successfully treated with laser photocoagulation as a result of the onward referral. Five years on, she is better at attending appointments, still has good vision and is able to see her grandchildren grow up.
Sadly, this month, as a result of NHS cuts and various new criteria for the screening service, diabetic screening will leave optometry practices and go out into the community. Patients will be booked into appointments at various locations across the county. It worries me that many of the patients we have helped over many years in optometry screening will no longer attend and may suffer more sight loss as a consequence. We have always offered weekend screening appointments for patients who work and many have expressed concerns about how they will attend appointments on weekdays.
But it was an elderly gentleman who pulled at the heartstrings at his recent screening appointment with us. When told of the new arrangement for next time he started to cry and asked if he could still come to us for screening. He said he has enough health appointments and doesn’t want an additional one at some unknown location. He knows and trusts us and has seen the same people for many years – familiarity is important to him at his age. He was adamant that he won’t attend future appointments if they aren’t with us. I hope he does, but I totally understand where he is coming from and doubt that he will.
Judy Lea is optometrist director of Specsavers, Longton, Staffordshire.