Impact of COVID-19 and recovery of routine diabetic retinopathy digital screening across different regions in England: an analysis of publicly available data.

Objective: This study aims to examine the reduction and subsequent recovery of routine digital screening (RDS) uptake in England from 2018 to 2022, exploring national, regional and individual Diabetic Eye Screening Programme (DESP) levels. The COVID-19 lockdown in most areas of England was from 26 March 2020 to 23 June 2020 (first national lockdown), 5 November 2020 to 2 December 2020 (second national lockdown) and 6 January 2021 to 8 March 2021 (third national lockdown).

Design: Retrospective data analysis.

Setting: DESPs of England.

Participants: Individuals with diabetes who were invited to take part in the DESP programmes.

Methods: Publicly available data from Public Health England (2018-2019) and National Health Service England (2019-2022) were examined to identify the rate of uptake (proportion of those who attended the DESPs to those who were invited) of RDS at national and regional levels and by each DESP in England.

Primary Outcome Measures: Rate of uptake of RDS.

Results: The national uptake of RDS decreased from 82% (2019-2020) to 68% (2020-2021) and then increased to 78% (2021-2022). At the regional level, the sharpest drop was in the Midlands which decreased from 79% (2019-2020) to 53% (2020-2021), increasing to 73% (2021-2022) but did not reach pre-COVID-19 levels. At individual DESP levels across England, the greatest drop in attendance (2020-2021) was recorded in Derbyshire (79% to 45%), Barnsley and Rotherham (78% to 45%) and Arden, Herefordshire and Worcestershire (78% to 46%). Although these DESPs showed an increase in 2021-2022 of 33%, 21% and 31%, they did not reach prepandemic (2018-2019) rates of 81%, 85% and 82%, respectively. Data suggest that West Sussex, East Sussex and East and North Hertfordshire DESPs maintained relatively higher uptake rates (86%-89%) in 2020-2021.

Conclusion: COVID-19 had an impact on England's diabetic eye screening attendance, with notable variations across regions and DESPs. Different regions and DESPs showed variable post-COVID-19 recovery. More importantly, what was not evident is the increased uptake that should have occurred after the COVID-19 lockdown to compensate for the low uptake during the lockdown. In some areas, addressing some of the barriers that affect retinal screening uptake may improve future attendance.