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Understanding national grading results and outcomes

Screening for diabetic retinopathy

NYDESP invite all eligible people with diabetes for an annual screening for diabetic eye disease. In some case we screen people more frequently (please see the table below) in our digital surveillance clinics for closer monitoring. We send the screening results to the person with diabetes and their GP.

Screening does not look for other eye conditions and we advise people with diabetes to continue to visit their optician regularly for an eye examination. However, if we see evidence of another eye condition which needs either urgent or routine assessment by an eye specialist, we refer directly to the local hospital.

If you need to find out when somebody is due screening or they have been referred to the local hospital, please contact us on 01904 726640. You will need the permission of the person you are enquiring about.

Grading outcomes

Grading result

Grade

Patient letter

Outcome

No retinopathy

R0M0

Results appeared normal

Annual recall

Background retinopathy

R1M0

Background Retinopathy

Annual recall

Maculopathy - low risk

R1M1

Maculopathy

Closer monitoring screening. 3, 6 or 9 month recall with OCT scan

Maculopathy - high risk

R1M1/ R3SM1

Maculopathy

Routine referral to an eye specialist. Appointment should be within 13 weeks of screening date

Pre-proliferative – low risk

R2M0

Pre-proliferative

Closer monitoring screening. 3, 6 or 9 month recall with multi-field photography

Pre-proliferative – high risk

R2M0

Pre-proliferative

Routine referral to an eye specialist. Appointment should be within 13 weeks of screening date

Pre-proliferative and maculopathy

R2M1

Maculopathy

Routine referral to an eye specialist. Appointment should be within 13 weeks of screening date

Proliferative

R3AM0 R3AM1

Proliferative

Urgent referral to an eye specialist. Appointment should be within 6 weeks of screening date

Treated stable proliferative

R3SM0

Treated stable proliferative

Closer monitoring screening. 3, 6 or 9 month recall with multi-field photography

Unassessable

U

Photographs were not clear enough

Referral to an SLB clinic. Appointment should be within 13 weeks of screening date

 

Table to show the possible results and outcomes

No retinopathy R0M0

The retina appears normal. The next appointment will be in routine digital screening in 12 months.

Background retinopathy R1M0

The retina shows small changes in the blood vessels which do not require treatment or closer monitoring. The next appointment will be in routine digital screening in 12 months.

Diabetic maculopathy – low risk R1M1

The retina shows maculopathy that does not require treatment. The next appointment will be in a surveillance clinic for closer monitoring. Closer monitoring screening for maculopathy is offered at either 3, 6 or 9 month intervals with 2 field photography and an OCT. The appointment is still in the community with the same screening staff, but it might not be at the local GP surgery.

Diabetic maculopathy – high risk R1M1/ R3SM1

The retina shows maculopathy that need further assessment or treatment. The next appointment will be at the local hospital with an eye specialist.

Pre-proliferative retinopathy (moderate) – low risk R2M0

The retina shows moderate pre-proliferative changes. The next appointment will be in a surveillance clinic for closer monitoring. Closer monitoring screening for pre-proliferative disease is offered at either 3, 6 or 9 month intervals with multi-field photography. We will take about 8 photographs of each eye so that we can see more of the retina. The appointment is still in the community with the same screening staff, but it might not be at the local GP surgery.

Pre-proliferative retinopathy (severe) – high risk R2M0 / R2M1

The retina shows severe pre-proliferative changes that need further assessment. The next appointment will be at the local hospital with an eye specialist. Severe pre-proliferative eye disease is more likely to progress to proliferative retinopathy that needs treatment within a year.

Proliferative retinopathy R3AM0 / R3AM1

The retina shows proliferative changes which need urgent assessment or treatment by an eye specialist. The next appointment will be at the local hospital with an eye specialist.

Stable treated proliferative retinopathy R3SM0

The retina shows evidence of PRP and stable treated proliferative retinopathy. The next appointment will be in a surveillance clinic for closer monitoring. Closer monitoring screening for stable treated proliferative retinopathy is offered at either 6, 9 or 12 month intervals with multi-field photography. We will take about 8 photographs of each eye so that we can see more of the retina. The appointment is still in the community with the same screening staff, but it might not be at the local GP surgery.

Unassessable

The retinal photographs are not clear enough for us to see enough of the retina. The next appointment will be in a slit lamp clinic with an SLB examiner. The appointment is still in the community with a qualified SLB examiner, but it might not be at the local GP surgery.

Non-diabetic retinopathy eye conditions

The retina shows evidence of another eye condition which needs either urgent or routine assessment or treatment by an eye specialist. A direct referral will be made at the local hospital with an eye specialist. The person with diabetes will also continue to be screened for DR appropriately in NYDESP.

Screening does not look for other eye conditions and we advise people with diabetes to continue to visit their optician regularly for an eye examination.

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Visiting cancelled

Due to the increasing number of cases of coronavirus across the UK, York Teaching Hospital NHS Foundation Trust has made the decision to cancel all visiting to all its hospital sites in order to ensure the safety of patients and staff.

There are three exemptions to the ruling which are for one parent of a sick child under 18, for the partner of a woman giving birth and end of life patients at the discretion of the ward sister.

We would ask people to respect this decision and to treat our staff, who will be enforcing the visiting restrictions, with courtesy and respect.  For more information visit our website.


Outpatient appointments

We know that NHS services will come under intense pressure as the coronavirus spreads, and as a Trust we need to redirect staff, free up staff for refresher training and carry out any works as necessary, so we are able to maximise capacity for patients for when the number of infections peak.  We also need to reduce the number of people coming into our hospitals to protect our patients, as well as keeping our staff safe, well and able to come into work.

To do this, with effect from Tuesday 24 March 2020, along with other trusts in the Humber Coast and Vale partnerships, we have made the collective decision to suspend all non-urgent routine outpatient appointments for at least three months.  Urgent and emergency cases and cancer appointments will be carrying on as normal.

These are unprecedented times and we thank you for your understanding.  We know many people waiting for treatment will be disappointed or worried but please not contact the hospital as we will be contacting everyone directly affected in the coming days and weeks.

If you do not receive a letter or a phone call from the hospital, please turn up for your scheduled appointment as normal unless you have symptoms of coronavirus, a cold, flu or norovirus in which case you should contact us to cancel your appointment by clicking here.


Coronavirus (COVID-19)

If you have symptoms associated with coronavirus including a new continuous cough and a high temperature, you are advised to stay at home for 7 days.

Please do not book a GP appointment or attend your GP practice.

If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.  After 14 days, anyone you live with who does not have symptoms can return to their normal routine.

But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days. The most up-to-date public guidance is always online at www.nhs.uk/coronavirus

If your symptoms are serious, or get worse, NHS 111 has an online coronavirus service that can tell you if you need further medical help and advise you what to do.  Only call 111 direct if you are advised to do so by the online service or you cannot go online.