The impact of cessation of screening for diabetic eye disease on people with diabetes during the COVID-19 pandemic

End of project summary

Main Messages

Impact of Covid-19 on diabetic eye screening in Wales (DESW)
The pandemic disrupted diabetic eye screening services in that screening was formally stopped from March to September 2020. This resulted in significant delays and a much-reduced clinic capacity due to difficulties in obtaining screening venues and staff availability. The consequences were that within 12 months of lockdown, only 13% of patients were rescreened, increasing to 20% within 24 months.

Service Recovery and Prioritisation
Based on initial prioritisation according to risk of progression of diabetic retinopathy post pandemic there was an increase in referrals for potentially sight-threatening diabetic retinopathy (15%) and diabetic maculopathy (17%) within the first year of resumed screening. The rate fell to 9% and 5% respectively, within 2 years, and continued to reach pre-pandemic levels, thereafter, demonstrating effective triaging.

Ophthalmology and Delayed Interventions
Hospital ophthalmology services were delayed during the pandemic, contributing to a 2.8-fold increase in the requirement for bilateral laser treatments post-pandemic. This underscores the critical need for timely care to prevent sight loss.

Screening Intervals and Risk
Findings suggest biennial screening is safe for low-risk individuals i.e. persons with either no retinopathy in the 12 months prior to lockdown, with low rates of progression to referable disease (0.3% for diabetic retinopathy; 6% for diabetic maculopathy with potentially 0.6% requiring treatment for diabetic maculopathy). In those with no evidence of diabetic retinopathy pre-Covid 16% developed evidence of background diabetic retinopathy within the period of the study. 

Communication Challenges
Importantly, communication gaps during the pandemic, between the screening service and people registered with the service, resulted in considerable anxiety in those affected and hindered healthcare professionals’ ability to reassure their patients. Enhancing communication strategies, particularly making available information in a timely and informative manner is therefore crucial.