In an important new finding, we uncovered confusion between routine retinal photography at optometry practices during eye examinations and DRS. While optometry photography may represent an important safeguard for non-attenders,

it could impair more comprehensive coverage. We observed differences between patients screened at GP versus optometrist practices, identifying that ease of making an appointment, Imatinib including its time, navigating home after the mydriasis drops, etc, appeared less problematic at GP practices. Furthermore, making patients responsible for arranging appointments in some regions, combined with encountering delays, could undermine the perceived importance of DRS. We have identified patients’ misperceptions about their attendance regularity. Strengths and limitations of the study

The strengths of this study include the purposive sampling strategy across several strata of professional groups in GP and optometry practices and screening programmes, and recruiting regular and less regular attending patients. Additionally, we recruited from diverse city, town and rural locations, and included programmes with different regional invitation and delivery modes. However, not every permutation between location type, deprivation and delivery mode was studied. We did not recruit any practice that delivers screening in a mobile unit or hospital outpatients department; so did not interview Hospital Eye Service staff, and only two practices provided optometrist screening. The qualitative findings from our purposive sample are not intended to be representative but to highlight sociocultural meanings of health and illness experiences, not simply their frequency, and identify important insights into barriers and enablers to screening attendance among our participants that will inform further research. Implications for clinicians and policy makers While some patients understood retinopathy and its

causation, others lacked information and understanding about DRS. This calls for proactive personal clinical risk communication28 29 and attendance information to ensure care coordination between patients, Batimastat primary care, screeners and screening programmes. The current guidance to bring sunglasses could be strengthened in the patient information. Some patients had confused retinal photography at optometry practices with DRS. Professional optometry bodies could ensure clarity among members, and optometrists should highlight the difference to their patients. Consideration may be appropriate around the responsibility that the NHS has when discharging visually impaired patients into the community. In Scotland, a 3-stage screening procedure is used; stage 1 is one field non-mydriatic photography, stage 2 is dilation, stage 3 is slit-lamp biomicroscopy on those with poor quality mydriatic images who required dilation in stage 2. The Scottish Screening Programme dilate approximately 34% of their population.