Optometrist screening for diabetic retinopathy: evidence and environment

A recent English government-funded study has suggested that optometrists are not best suited to screening for diabetic retinopathy. This is surprising given the level of training of optometrists and their aptitude in detecting other conditions such as glaucoma and cataract. The need to screen for diabetic retinopathy is discussed. The major unresolved issue concerns the choice of screening modality, i.e. who should perform screening, when and how. A literature search is reported. Given the available evidence, to make conclusions about the relative performance of optometrists with other screeners would be inappropriate. Unresolved controversies could be addressed by new prospective studies of optometrists, and others, in screening. A pragmatic design, mirroring the current environment of care, may be important. In particular, the manner in which diabetics currently present to the health service would make screening by one modality of limited use. If thoughtfully applied, shared care concepts may achieve a broader coverage of patients with diabetics mellitus. Smaller trials investigating sub-issues, and surveys of patients and potential screeners may produce a valuable backdrop in designing appropriate studies. Issues for the development of screening schemes are considered, including the role of training, the development of protocols for care and sharing data, reimbursement and audit.