Addressing Technical Failures in a Diabetic Retinopathy Screening Program [Response to Letter]

Dear editor

We appreciate the authors’ comments on our manuscript.¹

Our paper focuses on addressing technical failures when capturing fundal images in a nationwide community-based diabetic retinopathy screening program. Patients undergo colour photography, and those with maculopathy and best corrected visual acuity (BCVA) of 6/18 or better also have digital surveillance using a combination of colour digital photography and optical coherence tomography (OCT). Patients with maculopathy and BCVA of worse than 6/18 or with sight-threatening retinopathy i.e. pre-proliferative or proliferative retinopathy are referred to a medical retinal ophthalmologist in the nearest treatment centre.

While OCT during screening in the community can rule out macular pathology and avoid referral to a treatment centre, the retinopathy grade remains unknown if the images cannot be graded. Patients with ungradable images or who are unable to position for photography, are referred to a local optometrist for further assessment using slit lamp biomicroscopy.

If further investigation is required, the patient is then referred to a medical retinal ophthalmologist in the patient’s nearest treatment centre where comprehensive multimodal imaging can be performed.