It's the first of April, which means that from today onwards, local Diabetic Eye Screening Programmes in England will take their first tentative steps down the rocky road to a common pathway. By this time next year, we should all be singing from the same hymn sheet and looking alike. It's as if Jedward are working on a gospel album.

The new national website is already up and running, a new name has been adopted, and issues of 'DES News' are being published online to a potential global readership of just over two billion. Although that's expected to fall when people realise it's not about Des O'Connor. The January edition outlined the changes which will be implemented over the next twelve months to bring screening programmes into line with each other, as well as updating us on the outcome of a recent online consultation which will inform the final decisions on policies.

Those decisions were due to be made in March, and probably have been, but as a humble screener/grader, I'm not privy to such high-level decision-making, and can't be bothered to ask, so I'm still very much in the dark. Which is handy for grading. Despite that position of deep ignorance, I am, however, willing to conduct my own online consultation by inflicting my views on the web, and ruling on those policies myself. I'm like the man from Del Monte. Only less decisive. I think.

One of the hottest potatoes to be chipped away at in the recent online mash-up, is the issue of whether or not to arbitrate between R1/R0. Some of the country's leading ophthalmologists and programme managers have failed to agree on this policy, so it's only fitting that the decision is passed on to a third full-disease grader, who can settle the dispute and make that final decision. So here goes...

The answer's no. In fact, I'll go further. The debate about the benefits, cost-effectiveness, accuracy and outcome of arbitration is a complete red herring. What we should be discussing is not whether to arbitrate between R1/R0, but how screening programmes can eradicate those disagreements in the first place. And that, my friends, is easy. We need to redefine R0.

In my experience, disagreements between R1 and R0 fall into one of two categories:

(i) One grader spots a single microaneurysm. The other grader misses it.
(ii) Both graders spot the same feature, but disagree on whether or not it's retinopathy.

I would suggest that the overwhelming majority of cases fall into the second of those groups. Arbitration grading is not about clear-cut cases of retinopathy or blatant mistakes, it's about agonising over that brownish red dot, and deciding if it's pigment. And that does nobody any favours. Least of all the patient.

One solution might be the use of automated grading to differentiate between R1 and R0, but that has cost implications, and could ultimately lead to the development of Skynet, as depicted in the Terminator films. So it's probably best avoided.

Instead, I propose an entirely new set of grading criteria: The Diabetic Eye Screening Programme's Electronic Rating System. Or DESP E-Rate. Under the DESP E-Rate measures I'm proposing, we would expand the definition of R0 to include anything up to three microanuerysms in one eye. Only when four or more MAs are found to be present, would the grade be raised to R1.

Overnight, this would eradicate the need to arbitrate between R1/R0. There isn't a grader in the country who would miss three microaneurysms in a single eye, and the chances of a patient having as many as four dubious dots are slim to none. Graders might disagree on one or two cases of pigment, but not four in one eye.

The result is that first and second disease graders would instantly be on a common pathway, agreeing on R1/R0 in every single case. In addition, the internal QA function previously provided by arbitrating between R1/R0 would be maintained, because any grader found to have missed more than three MAs in one eye could be sacked on the spot for incompetence.

The lack of disagreements would cause accuracy figures to rise, boosting public confidence in the screening programme, and the simultaneous decrease in retinopathy rates would result in an increase in happiness, a lowering of anxiety and blood pressure, and an overall improvement in the health of the nation. Stress would go down, productivity up, and within five years of adopting these DESP E-Rate measures, UK recession would be a thing of the past.

Admittedly, raising the threshold for R1 would introduce a potential for patients with three MAs in each eye to be given the all-clear, but my question is this: does it make a blind bit of difference? In a quite literal sense. And the answer is no. No one's going to lose their sight over a couple of MAs, and the benefits greatly outweigh the risks.

Take two typical patients: firstly, a twenty-something type 1 with a history of poor control, who has two dozen microaneurysms, a handful of dot haemorrhages, and some exudates outside the macula. And secondly, a newly diagnosed, diet-controlled pensioner, who presents for her first screening appointment with a questionable reddish dot on the nasal view.

Under the old grading criteria, these two patients, who are posterior poles apart in pathology, would receive the same result. Under the DESP E-Rate system, an important distinction would be made. It's about accepting that a hazy red dot, viewed through a slight cataract in the eye of an octogenarian, does not constitute retinopathy.

We're all familiar with the term 'Clinically Significant Macular Oedema', so why not extend that concept to R1? Why not agree that a lone microaneurysm is not clinically significant, and can be safely ignored. If the patient comes back with four, then we'll talk. But in the meantime, we can pull those graders off the arbitration list, and get back to saving sight.