Diabetic eye screening (DES): care pathway
Updated 2 October 2023
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This flowchart and alternative text describes the screening pathway for the NHS DES Programme.
1. Person with diabetes identified to screening service.
Go to step 2.
2. Is person eligible for screening?
Yes: Go to step 3.
No: Exclude or suspend according to national guidance. End of pathway.
3. Is person pregnant?
Yes: Refer to DES pregnancy pathway. End of this pathway.
No: Offer routine digital screening (RDS). Go to step 4.
4. Do they accept screening offer?
Yes: Go to step 5.
No: Opt out of screening following opt-out process. End of pathway.
5. Does the person postpone screening?
Yes: Reinvite for screening in requested timeframe. Go to step 6.
No: Go to step 6.
6. Does the person attend screening?
Yes: Carry out screening test. Go to step 8.
No: Offer second appointment. Go to step 7.
7. Does person attend second screening appointment?
Yes: Carry out screening test. Go to step 8.
No: Reinvite for RDS in 12 months’ time. End of pathway.
8. Are images obtained?
Yes: Grade images. Go to step 10.
No: Go to step 9.
9. Attempt screening again?
Yes: Reinvite for screening in requested timeframe. Go to step 6.
No: Refer to slit lamp biomicroscopy (SLB)/hospital eye services (HES), or exclude. End of pathway.
10. Is the grading outcome referable?
Yes: Go to step 11.
No: Reinvite for RDS in 12 or 24 months’ time. End of pathway.
11. Is image ungradable in both eyes?
Yes: Refer to SLB and suspend from RDS. End of pathway.
No: Go to step 12.
12. Is referable diabetic retinopathy present?
Yes: Go to step 13.
No, outcome is ungradeable in one eye or referable non-DR: Follow referable non-DR guidance. Reinvite for RDS/SLB in 12 months’ time. End of pathway.
13. Is person suitable for monitoring in digital surveillance (DS)?*
Yes: Refer to DS and suspend from RDS. End of pathway.
No: Refer to HES and suspend from RDS. End of pathway.
*Depending on local guidance, grading outcomes suitable for monitoring in DS can include R3S, R2 and M1.