Screening
Screening for retinopathy is reported to be cost-effective.[78] The condition can progress to a sight-threatening stage with few symptoms.[79] Although effective treatments exist, they are more effective at preventing than at reversing visual loss.[74][80] Clinical outcomes are improved if intervention is undertaken early.[81]
The American Academy of Ophthalmology (AAO) recommends screening for retinopathy as follows.[62]
In type 1 diabetes: 5 years after onset, with yearly follow-up.
In type 2 diabetes: at time of diagnosis of diabetes, with yearly follow-up.
In pregnancy with pre-existing diabetes: soon after conception and early in the first trimester, with follow-up every 3 to 12 months for none, mild, and moderate non-proliferative diabetic retinopathy, and 1 to 3 months for severe or worse non-proliferative diabetic retinopathy.
The American Diabetes Association recommends a similar screening protocol to the AAO:[61]
In type 1 diabetes: initial dilated and comprehensive eye examination within 5 years of onset, with follow-up every 1 to 2 years if no retinopathy is detected and glycaemia is well controlled.
In type 2 diabetes: initial dilated and comprehensive eye examination at time of diagnosis of diabetes, with follow-up every 1 to 2 years if no retinopathy is detected and glycaemia is well controlled.
In pregnancy with pre-existing type 1 or type 2 diabetes: an eye examiation should be conducted before pregnancy and in the first trimester, with monitoring every trimester and for 1 year postnatal, as indicated by the degree of retinopathy.
Digital fundus photography is the preferred method of screening because it provides a permanent record for quality assurance and audit.[82] Retinal photography (with remote reading or use of a validated assessment tool) may be of benefit in areas where qualified eye care professionals are not readily available.[61] Nevertheless, it requires training, can miss disease outside the area photographed, and, if non-stereoscopic, may be less sensitive than ophthalmoscopy in the detection of diabetic macular oedema. Retinal photography is not a substitute for a comprehensive eye examination, which should be performed at least initially, and at yearly intervals or more frequently thereafter, as recommended by an eye care professional.[61][83]
Barriers to screening for diabetic retinopathy exist. Racial and ethnic minorities are more likely to have diabetic retinopathy and diabetic macular oedema, but typically undergo less screening.[84] For example, in a US cohort study of 149 participants, non-white youths were less likely to report a previous diabetic eye examination (non-white individuals 46% vs. white individuals 85%), yet more likely to have diabetic retinopathy (15% vs. 3%).[85]
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