Clinical Ophthalmology (Oct 2020)
A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models
Abstract
Elizabeth Pearce,1 Sobha Sivaprasad1,2 1Department of Ocular Biology, Institute of Ophthalmology, University College London, London, UK; 2Medical Retina Department, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UKCorrespondence: Sobha SivaprasadNIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, NHS Foundation Trust, 162 City Road, London EC1V 2PD, UKTel +44 20 7253 3411Email [email protected]: Diabetic retinopathy (DR) is a microvascular complication of diabetes with a prevalence of ∼ 35%, and is one of the leading causes of visual impairment in people of working age in most developed countries. The earliest stage of DR, non-proliferative DR (NPDR), may progress to sight-threatening DR (STDR). Thus, early detection of DR and active regular screening of patients with diabetes are necessary for earlier intervention to prevent sight loss. While some countries offer systematic DR screening, most nations are reliant on opportunistic screening or do not offer any screening owing to limited healthcare resources and infrastructure. Currently, retinal imaging approaches for DR screening include those with and without mydriasis, imaging in single or multiple fields, and the use of conventional or ultra-wide-field imaging. Advances in telescreening and automated detection facilitate screening in previously hard-to-reach communities. Despite the heterogeneity in approaches to fit local needs, an evidence base must be created for each model to inform practice. In this review, we appraise different aspects of DR screening, including technological advances, identify evidence gaps, and propose several studies to improve DR screening globally, with a view to identifying patients with moderate-to-severe NPDR who would benefit if a convenient treatment option to delay progression to STDR became available.Keywords: telescreening, non-proliferative diabetic retinopathy, risk-stratification, systematic, opportunistic
