Diabetic eye screening: OCT in surveillance pathway
Updated 27 September 2024
Applies to England
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This flowchart (illustration and text description below) describes the diabetic eye screening (DES) ocular coherence tomography (OCT) pathway for individuals whose DES result is R1M1 or R3SM1.
1. R1M1 or R3SM1 diabetic eye screening result
Individual has screening result of R1M1 or R3SM1.
2. Is maculopathy low risk or high risk?
Low risk: refer within 13 weeks for spectral domain (SD) optical coherence tomography (OCT) scan in digital surveillance (DS) clinic. Go to 3.
High risk: refer within 13 weeks to hospital eye services (HES) clinic appointment. End of pathway.
High risk maculopathy is defined as:
- macular exudate (circinate) greater than 1/2 disc area and
- is within 1 DD of the fovea and
- there is a drop in visual acuity in this eye to less than or equal to 6/12
3. Is image gradable?
Yes: Go to 4.
No: Refer to HES clinic appointment. End of pathway.
4. Is image grade R1M1 or R3SM1 and OCT positive?
Yes: Refer to HES clinic appointment. End of pathway.
No: Go to 5.
5. Is image grade any R2 or R3A?
Yes: Refer to HES clinic appointment. End of pathway.
No: Go to 6.
6. Is image grade R1M1 or R3SM1 and OCT negative?
Yes: Refer to digital surveillance pathway (3, 6 12 months) with OCT. End of pathway.
No: Go to 7.
7. Is image grade R1M1 or R3SM1 and OCT borderline?
Yes: Refer to digital surveillance pathway (3, 6 12 months) with OCT. R1M0 OCT borderline is not possible if the OCT changes are caused by diabetic maculopathy. This would automatically become R1M1 OCT borderline or positive. OCT changes from other eye disease should be referred to hospital eye services. End of pathway.
No: Go to 8.
8. Is image grade R1M0 and OCT negative?
Yes: Refer to routine digital screening. End of pathway.
No: Go to 9.
9. Is image grade R3SM0 and OCT negative?
Yes: Refer to digital surveillance pathway without OCT. End of pathway
No: Image shows other eye disease (non-diabetic retinopathy or maculopathy). Refer to HES clinic. End of pathway.