Quality Standards for Diabetes Care Toolkit

Implementation advice

Guidelines for the minimum intervals for retinal monitoring (Ministry of Health 2008, p 6; Associate Professor Gordon Sanderson, personal communication, 18 June 2014) are presented below.

Retinal screening	Type 1 diabetes	Type 2 diabetes
Intervals for screening	Adult – screen when the duration of diabetes is more than five years. Children – Screening can be delayed until puberty or five years after diagnosis, whichever is the earlier. * Regular retinal screening should be conducted at least every two years if no abnormality is detected.	All patients should be screened as soon as possible after diagnosis.
Retinal/photo monitoring	Once any diabetic retinopathy is detected, the frequency of the assessments will need to be increased depending on the severity of the retinopathy and the risk factors for progression to sight-threatening disease. More information can be found on Table 5 – Grading for Diabetic Retinopathy (section 4.2) (Ministry of Health 2008).
During pregnancy	* All pregnant women should be screened in the first trimester of their pregnancy. Those who have no retinopathy and no clinical modifiers can then continue their normal two-yearly screening – see ‘Table 7 – Grading and referral guidelines for women who have diabetes and are also pregnant’ (section 4.4) for more information. Those with: some retinopathy will require more frequent screening or monitoring throughout the pregnancy more advanced retinopathy will require referral to an ophthalmologist for ongoing review during pregnancy. Also see Section 4.2, Grading for Diabetic Retinopathy.

* Some patients may require increased or reduced ‘ongoing monitoring’ (eg, patients with diet controlled diabetes with HbA1c less than 53 mmol/mol). These intervals are guidelines and ophthalmologists may vary monitoring intervals providing sensitivity and quality are not compromised.