Dr Peter Scanlon

Consultant Ophthalmologist
Cheltenham General Hospital

The FLURRI study.

A study designed to increase the understanding of the factors leading to low uptake of diabetic retinopathy screening in Primary Care has been awarded £220,000 funding from the NIHR Research for Patient Benefit (RfPB) Programme, obtained with RDS support.

Diabetes is a very common condition affecting 1 in 20 UK adults. One complication of diabetes is diabetic retinopathy, which occurs when diabetes damages the small blood vessels at the back of the eye (retina). Symptomless to the patient until it is in the advanced stages, if left untreated this can result in loss of vision and blindness. Diabetic retinopathy is the most frequently reported cause of blindness in the working age population in the UK. People with diabetes are invited to have digital photographs taken of the backs of their eyes (retinae) once a year. This can detect problems at an early stage when they can be treated and prevent further vision loss. However, a significant number of people invited for retinal photography do not attend, and may be putting themselves at risk of future blindness. Research has shown a relationship with non-attendance at screening and subsequent loss of vision

The FLURRI study, led by Dr Peter Scanlon, is interested in finding out why people do not attend to have their eyes photographed and will use this information to try to increase the number that do. It has been found that those in deprived areas are less likely to attend, but this does not explain all the variability between GP practices. Reasons given to screening programme staff for failure to attend include inconvenient timing of the appointment, the patient forgot, the attitude of the administrative staff booking the appointments and anxiety about screening. There may be cultural and language barriers in ethnic groups.

The study will choose GPs in Gloucestershire, Birmingham and Warwickshire, some with good levels of attendance and others with poor attendance, located in areas of high or low health need. Gloucestershire and Warwickshire run screening programmes using retinal screeners in mobile screening locations and, in Warwickshire, at fixed sites. The Birmingham programme uses high street optometrists. The research team will speak to health professionals in these practices to understand how they inform and educate people with diabetes about retinal screening. They will speak to patients, including those who have attended and those who have not, in order to see if there are ways in which uptake might be improved. They will also speak with retinal screeners and optometrists who undertaking the photographic screening.

Dr Peter Scanlon said “When considering how we should find out further information about the reasons for non-attendance in diabetic retinopathy screening, we approached the Research Design Service South West for assistance and we approached a group of researchers in Warwick who had experience in qualitative case-study research."