The English Diabetic Eye Screening Programme (DESP)—first set up in 2003 has proved very successful and is believed to be a key contributor to the reduction in DR-related blindness [1, 2]. Despite this success, there are limitations to the Programme. It is predicted that people diagnosed with diabetes, particularly type 2, will reach record high levels in the next decade and together with the increased cost of technology and personnel required to run each programme, sustaining and keeping DESP cost-effective in the long term is going to be challenging. Additionally, with increasing pressures on Hospital Eye Services (HES) to provide intravitreal anti-VEGF, steroid therapies, laser treatment and vitrectomies, there is a definite need to make changes to the DESP. This review article describes the three main changes that have recently been implemented within DESP to try to address these challenges. These include the introduction of 2-yearly screening of certain low-risk groups, the refinement of the R2 grade into low-risk (R2L) and high-risk (R2H) categories and the introduction of the Optical Coherence Tomography (OCT) surveillance pathway within DESP.
