Clinical Director of National Diabetic Retinopathy Screening Service expresses concern over viability of programme following recent legal judgement

ICO Annual Conference 2019

The viability of the national diabetic retinopathy screening programme, Diabetic RetinaScreen, may now be in danger, its clinical director Prof David Keegan has warned, due to the implications of a recent legal judgment on screening.

Addressing delegates at the Annual Conference of the Irish College of Ophthalmologists in Galway last Friday (May 17th), Prof David Keegan confirmed that he had examined the recent judgement by Mr Justice Kevin Cross in the Ruth Morrissey care carefully and consequently held an emergency meeting of the screening programme management team. It has now sought legal advice about whether the programme can continue to screen patients.

The ruling by Mr Justice Kevin Cross regarding slides being misread under the CervicalCheck programme has set a legal precedent for how negligence should be assessed in medical screening programmes, with "absolute confidence" deemed the standard that should be applied.

Speaking during a special discussion session on diabetic retinopathy screening at the ICO Conference, Prof Keegan noted that no screening test has 100pc specificity and sensitivity and that absolute confidence was an impossible ask.

He said it had been suggested that the programme could "tighten up" its patient information leaflets to stress the limitations of screening but he was uncertain this would be sufficient legally to deal with any future interpretation of the Cross ruling.

Echoing his points, Dr Alison Blake, outgoing president of the ICO, pointed out that medical screening was a very important population health measure, which could reduce but not eliminate entirely the risk of developing the advanced stages of a particular disease and that there was still a misperception about the basis and limitations of screening.

Prof Keegan and a number of doctors at the session voiced concern that the legal profession did not appreciate how the interpretation of the Cross judgment could affect their work and the viability of screening programmes.

It was pointed out that medico legal payout awards in Ireland are much higher than in the UK and that the cost of medical indemnity insurance is also far higher for Irish doctors.

There are around 200,000 people living with diabetes in Ireland.

Prof Keegan said that Diabetic RetinaScreen, which started in 2012 and now has 124 screening locations and seven treatment centres nationally, is delivering positive results for diabetic patients.

"We are detecting pre-symptomatic disease and providing sight-saving treatments in at risk patients. Uptake rates are steadily rising and we are confident that the true impact of our programme - the reduction in blindness and vision impairment due to diabetic retinopathy - will be achieved."

Diabetic RetinaScreen offers free annual screening to people with diabetes aged 12 years and older. Its uptake reached 61.7pc last year.

Diabetic retinopathy is an eye disease that can cause blindness in those with diabetes if it is not detected early enough.

23rd May 2019