What are the current guidelines for referring patients with diabetic retinopathy to ophthalmology for further management?

For patients with diabetic retinopathy, referral to ophthalmology for further management is guided by the findings of the NHS diabetic eye screening programme and specific clinical indicators ²,³.

• Emergency Ophthalmology Review should be arranged if there is:
  • Sudden loss of vision ²,³.
  • Rubeosis iridis (formation of abnormal blood vessels on the anterior iris) ²,³.
  • Pre-retinal or vitreous haemorrhage ²,³.
  • Retinal detachment ²,³.
• Urgent Ophthalmology Review should be arranged if there is:
  • Formation of new abnormal vessels on the retina (proliferative diabetic retinopathy) ²,³.
• Following structured eye screening, a patient may be referred to an ophthalmologist, have an earlier review, or continue with routine annual review, depending on the findings ²,³.
• When starting a diabetes treatment that is likely to result in a rapid, substantial drop in the person's HbA1c, the person's ophthalmologist should be notified so they can assess the eyes before treatment begins and check for changes afterwards ¹.
• Hospital eye services should monitor disease progression in people with moderate, severe, or very severe non-proliferative retinopathy who are not currently having treatment and have not previously had treatment ¹. This includes considering reviews every 6 to 12 months for moderate non-proliferative diabetic retinopathy, and every 3 to 6 months for severe or very severe non-proliferative retinopathy ¹.