Diabetic eye screening in doubt due to Cross judgement, warns Clinical Director

The viability of the national diabetic retinopathy screening programme, Diabetic RetinaScreen, is now in danger due to the implications of the recent Cross judgement,  the programme’s Clinical Director warned during the 2019 Irish College of Ophthalmologists (ICO) Annual Conference in Galway.

The ruling by Mr Justice Kevin Cross in the Ruth Morrissey court case regarding her slides being misread under the CervicalCheck programme has set a legal precedent for how negligence should be assessed in medical screening programmes.

According to the judgment,  “with absolute confidence” is deemed the standard that should be applied to the reading of all screening slides.

Diabetic RetinaScreen Clinical Director Prof David Keegan confirmed that having examined the judgment carefully, the programme held an emergency meeting of its management team and has now sought legal advice about whether it can continue screening patients in light of the ruling.

Speaking during a special discussion session on diabetic retinopathy screening at the conference, Prof Keegan noted that no screening test has 100 per cent specificity and sensitivity and that absolute confidence was an impossible ask of any screening programme.

Prof Keegan said it had been suggested that the programme could “tighten-up” its patient information and content leaflets to stress the limitations of screening and the reality of false-negatives and false-positives; however, he said he was uncertain this would be sufficient legally to deal with any future interpretation of the Cross ruling.

His points were echoed by Dr Alison Blake, outgoing President of the College, who pointed out that medical screening was a very important population health measure aimed at reducing the risk of developing the advanced stages of a particular disease. She noted the risk could not be entirely eliminated and that there was still a misperception about the basis and limitations of screening in the public and the media.

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, given the adversarial medico-legal culture here.

Prof Keegan stressed to the Medical Independent (MI) that those involved with the Diabetic RetinaScreen programme were very conscious and sympathetic of the impact on individual patients involved in the CervicalCheck controversy and that their primary concern was about protecting patients and ensuring the continuation of screening.

Earlier in the meeting, Prof Keegan said that Diabetic RetinaScreen, which commenced on a phased basis in 2012 and now has 124 screening locations and seven treatment centres nationally, is delivering positive results for diabetic patients in Ireland. “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, reduction in blindness and vision impairment due to diabetic retinopathy, will be achieved.”

The Diabetic RetinaScreen programme offers free, regular diabetic retinopathy screening to people with diabetes aged 12 years and older.