Skip to main content
Top

09-05-2017 | Retinopathy | Review | Article

Screening Intervals for Diabetic Retinopathy and Implications for Care

Journal: Current Diabetes Reports

Author: Peter H. Scanlon

Publisher: Springer US

Abstract

Purpose of Review

The purpose of this study is to review the evidence that lower risk groups who could safely be screened less frequently for sight-threatening diabetic retinopathy (DR) than annually.

Recent Findings

Data have demonstrated that people with no DR in either eye are at a low risk of progression to sight-threatening DR over a 2-year period (event rate 4.8 per 1000 person years), irrespective of whether the screening method is one-field non-mydriatic or two-field mydriatic digital photography. Low risk has been defined as no retinopathy on two consecutive screening episodes or no retinopathy on one screening episode combined with risk factor data.

Summary

The risk of an extension to 2 years is less than 5 per 1000 person years in a population with a national screening programme, and the general standard of diabetes care is relatively good, whether low risk is defined as no retinopathy on two consecutive screening episodes or no retinopathy on one screening episode combined with other risk factor data. The definition used in different populations is likely to depend on the availability of data.
Literature
1.
ONS. How has life expectancy changed over time? 2017. http://​visual.​ons.​gov.​uk/​how-has-life-expectancy-changed-over-time/​. Accessed 08/04/17.
2.
Roser M. Rising life expectancy around the world. 2017. https://​ourworldindata.​org/​life-expectancy/​. Accessed 08/04/2017.
3.
IDF. International Diabetes Federation. IDF Diabetes Atlas. Brussels, Belgium. 2017. http://​www.​diabetesatlas.​org/. Accessed 08/04/17.
4.
Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414(6865):782–7.CrossRefPubMed
5.
Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol. 2012;60(5):428–31.CrossRefPubMedPubMedCentral
6.
Kristinsson JK, Stefansson E, Jonasson F, Gislason I, Bjornsson S. Screening for eye disease in type 2 diabetes mellitus. Acta Ophthalmol. 1994;72(3):341–6.CrossRef
7.
Kristinsson JK, Stefansson E, Jonasson F, Gislason I, Bjornsson S. Systematic screening for diabetic eye disease in insulin dependent diabetes. Acta Ophthalmol. 1994;72(1):72–8.CrossRef
8.
Agardh E, Agardh CD, Hansson-Lundblad C. The five-year incidence of blindness after introducing a screening programme for early detection of treatable diabetic retinopathy. Diabet Med. 1993;10(6):555–9.CrossRefPubMed
9.
Facey K, Cummins E, Macpherson K, Morris A, Reay L, Slattery J. Organisation of Services for Diabetic Retinopathy Screening. Glasgow: Health Technology Board for Scotland 2002.
10.
Gillow JT, Gray JA. The National Screening Committee review of diabetic retinopathy screening. Eye. 2001;15(Pt 1):1–2.CrossRefPubMed
11.
Thomas RL, Dunstan FD, Luzio SD, Chowdhury SR, North RV, Hale SL et al. Prevalence of diabetic retinopathy within a national diabetic retinopathy screening service. Br J Ophthalmol 2014 1–5. https://​doi.​org/​10.​1136/​bjophthalmol-2013-304017.
12.
Vujosevic S, Midena E. Diabetic retinopathy in Italy: epidemiology data and telemedicine screening programs. J Diabetes Res. 2016;2016:3627465. https://​doi.​org/​10.​1155/​2016/​3627465.CrossRefPubMedPubMedCentral
13.
Bandurska-Stankiewicz E, Wiatr D. Diabetic blindness significantly reduced in the Warmia and Mazury Region of Poland: Saint Vincent Declaration targets achieved. Eur J Ophthalmol. 2006;16(5):722–7.PubMed
14.
DiabeticRetinaScreen. Diabetic Retinopathy Screening in Ireland. 2017. https://​www.​diabeticretinasc​reen.​ie/​screening.​10.​html. Accessed 09/04/2017.
15.
Wong TY, Cheung N, Tay WT, Wang JJ, Aung T, Saw SM, et al. Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. Ophthalmology. 2008;115(11):1869–75.CrossRefPubMed
16.
Fransen SR, Leonard-Martin TC, Feuer WJ, Hildebrand PL. Clinical evaluation of patients with diabetic retinopathy: accuracy of the Inoveon diabetic retinopathy-3DT system. Ophthalmology. 2002;109(3):595–601.CrossRefPubMed
17.
Silva PS, Cavallerano JD, Tolls D, Omar A, Thakore K, Patel B, et al. Potential efficiency benefits of nonmydriatic ultrawide field retinal imaging in an ocular telehealth diabetic retinopathy program. Diabetes Care. 2014;37(1):50–5. https://​doi.​org/​10.​2337/​dc13-1292.CrossRefPubMed
18.
Murray RB, Metcalf SM, Lewis PM, Mein JK, McAllister IL. Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership. Med J Aust. 2005;182:520–3.PubMed
19.
Cavallerano JD, Silva PS, Tolson AM, Francis T, Tolls D, Patel B, et al. Imager evaluation of diabetic retinopathy at the time of imaging in a telemedicine program. Diabetes Care. 2012;35(3):482–4.CrossRefPubMedPubMedCentral
20.
Kirkizlar E, Serban N, Sisson JA, Swann JL, Barnes CS, Williams MD. Evaluation of telemedicine for screening of diabetic retinopathy in the Veterans Health Administration. Ophthalmology. 2013;120(12):2604–10. https://​doi.​org/​10.​1016/​j.​ophtha.​2013.​06.​029.CrossRefPubMed
21.
Klein R, Lee K, Gangnon R, Klein B. The 25-year incidence of visual impairment in type 1 diabetes mellitus: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Evid Based Ophthalmol. 2010;12(1):28–9.
22.
Pradeepa R, Anjana RM, Unnikrishnan R, Ganesan A, Mohan V, Rema M. Risk factors for microvascular complications of diabetes among south Indian subjects with type 2 diabetes—the Chennai urban rural epidemiology study (CURES) eye study-5. Diabetes Technol Ther. 2010;12(10):755–61. https://​doi.​org/​10.​1089/​dia.​2010.​0069.CrossRefPubMed
23.
You QS, Xu L, Wang YX, Liang QF, Cui TT, Yang XH, et al. Prevalence of diabetic retinopathy as cause for visual impairment: the Beijing Public Health Care Project. Clin Experiment Ophthalmol. 2013;41(6):608–9. https://​doi.​org/​10.​1111/​ceo.​12053.CrossRefPubMed
24.
Schellini SA, De Carvalho GM, Rendeiro FS, Padovani CR, Hirai FE. Prevalence of diabetes and diabetic retinopathy in a Brazilian population. Ophthalmic Epidemiol. 2014;21(1):33–8. https://​doi.​org/​10.​3109/​09236586.​2013.​868004.CrossRefPubMed
26.
Scanlon PH, Malhotra R, Thomas G, Foy C, Kirkpatrick JN, Lewis-Barned N, et al. The effectiveness of screening for diabetic retinopathy by digital imaging photography and technician ophthalmoscopy. Diabet Med. 2003;20(6):467–74.CrossRefPubMed
27.
Spijkerman AM, Dekker JM, Nijpels G, Adriaanse MC, Kostense PJ, Ruwaard D, et al. Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the Hoorn screening study. Diabetes Care. 2003;26(9):2604–8.CrossRefPubMed
28.
Bek T, Lund-Andersen H, Hansen AB, Johnsen KB, Sandbaek A, Lauritzen T. The prevalence of diabetic retinopathy in patients with screen-detected type 2 diabetes in Denmark: the ADDITION study. Acta Ophthalmol. 2009;87(3):270–4.CrossRefPubMed
29.
Pang C, Jia L, Jiang S, Liu W, Hou X, Zuo Y, et al. Determination of diabetic retinopathy prevalence and associated risk factors in Chinese diabetic and pre-diabetic subjects: Shanghai diabetic complications study. Diabetes Metab Res Rev. 2012;28(3):276–83. https://​doi.​org/​10.​1002/​dmrr.​1307.CrossRefPubMed
30.
Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–64.CrossRefPubMedPubMedCentral
31.
Zetoc. The monitoring and search service for global research publications. 2017. http://​zetoc.​jisc.​ac.​uk/. Accessed 09/04/2017.
32.
Younis N, Broadbent DM, Harding SP, Vora JP. Incidence of sight-threatening retinopathy in Type 1 diabetes in a systematic screening programme. Diabet Med. 2003;20(9):758–65.CrossRefPubMed
33.
Younis N, Broadbent DM, Vora JP, Harding SP. Incidence of sight-threatening retinopathy in patients with type 2 diabetes in the Liverpool Diabetic Eye Study: a cohort study. Lancet. 2003;361(9353):195–200.CrossRefPubMed
34.
Olafsdottir E, Stefansson E. Biennial eye screening in patients with diabetes without retinopathy: 10-year experience. Br J Ophthalmol. 2007;91(12):1599–601.CrossRefPubMedPubMedCentral
35.
Misra A, Bachmann MO, Greenwood RH, Jenkins C, Shaw A, Barakat O, et al. Trends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programme. Diabet Med. 2009;26(10):1040–7.CrossRefPubMed
36.
Soto-Pedre E, Hernaez-Ortega MC, Vazquez JA. Six-year retrospective follow-up study of safe screening intervals for sight-threatening retinopathy in patients with diabetes mellitus. J Diabetes Sci Technol. 2009;3(4):812–8.CrossRefPubMedPubMedCentral
37.
Agardh E, Tababat-Khani P. Adopting 3-year screening intervals for sight-threatening retinal vascular lesions in type 2 diabetic subjects without retinopathy. Diabetes Care. 2011;34(6):1318–9. https://​doi.​org/​10.​2337/​dc10-2308.CrossRefPubMedPubMedCentral
38.
Scanlon PH, Stratton IM, Histed M, Chave SJ, Aldington SJ. The influence of background diabetic retinopathy in the second eye on rates of progression of diabetic retinopathy between 2005 and 2010. Acta Ophthalmol. 2013;91(5):e335–9. https://​doi.​org/​10.​1111/​aos.​12074.CrossRefPubMedPubMedCentral
39.
Porta M, Maurino M, Severini S, Lamarmora E, Trento M, Sitia E, et al. Clinical characteristics influence screening intervals for diabetic retinopathy. Diabetologia. 2013;56(10):2147–52. https://​doi.​org/​10.​1007/​s00125-013-2989-7.CrossRefPubMed
40.
• Leese GP, Stratton IM, Land M, Bachmann MO, Jones C, Scanlon P, et al. Progression of diabetes retinal status within community screening programs and potential implications for screening intervals. Diabetes Care. 2015;38(3):488–94. https://​doi.​org/​10.​2337/​dc14-1778. This work was influential in combining data from the UK screening programmes that use different methodologies (e.g. Scotland use one-field staged mydriasis, England and Wales use 2-field mydriatic digital photography and Northern Ireland routine mydriasis over 55 years and staged mydriasis under 55 years). CrossRefPubMed
41.
Hughes D, Nair S, Harvey JN. Determining diabetic retinopathy screening interval based on time from no retinopathy to laser therapy. J Med Screen. 2016; https://​doi.​org/​10.​1177/​0969141316672687​.
42.
Aspelund T, Thornorisdottir O, Olafsdottir E, Gudmundsdottir A, Einarsdottir AB, Mehlsen J, et al. Individual risk assessment and information technology to optimise screening frequency for diabetic retinopathy. Diabetologia. 2011;54(10):2525–32. https://​doi.​org/​10.​1007/​s00125-011-2257-7.CrossRefPubMed
43.
Mehlsen J, Erlandsen M, Poulsen PL, Bek T. Individualized optimization of the screening interval for diabetic retinopathy: a new model. Acta Ophthalmol. 2012;90(2):109–14.CrossRefPubMed
44.
Chalk D, Pitt M, Vaidya B, Stein K. Can the retinal screening interval be safely increased to 2 years for type 2 diabetic patients without retinopathy? Diabetes Care. 2012;35(8):1663–8. https://​doi.​org/​10.​2337/​dc11-2282.CrossRefPubMedPubMedCentral
45.
•• Stratton IM, Aldington SJ, Taylor DJ, Adler AI, Scanlon PH. A simple risk stratification for time to development of sight-threatening diabetic retinopathy. Diabetes Care. 2013;36(3):580–5. https://​doi.​org/​10.​2337/​dc12-0625. This was the first report of the method if risk stratification based on two negative screens. CrossRefPubMedPubMedCentral
46.
Looker HC, Nyangoma SO, Cromie DT, Olson JA, Leese GP, Philip S, et al. Predicted impact of extending the screening interval for diabetic retinopathy: the Scottish Diabetic Retinopathy Screening programme. Diabetologia. 2013;56(8):1716–25. https://​doi.​org/​10.​1007/​s00125-013-2928-7.CrossRefPubMedPubMedCentral
47.
Day TE, Ravi N, Xian H, Brugh A. Sensitivity of diabetic retinopathy associated vision loss to screening interval in an agent-based/discrete event simulation model. Comput Biol Med. 2014;47:7–12. https://​doi.​org/​10.​1016/​j.​compbiomed.​2014.​01.​007.CrossRefPubMed
48.
Lund SH, Aspelund T, Kirby P, Russell G, Einarsson S, Palsson O, et al. Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs. Br J Ophthalmol. 2016;100(5):683–7. https://​doi.​org/​10.​1136/​bjophthalmol-2015-307341.CrossRefPubMed
49.
Vijan S, Hofer TP, Hayward RA. Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus. JAMA. 2000;283(7):889–96.CrossRefPubMed
50.
•• Scanlon PH, Aldington SJ, Leal J, Luengo-Fernandez R, Oke J, Sivaprasad S, et al. Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening. Health Technol Assess. 2015;19(74):1–116. https://​doi.​org/​10.​3310/​hta19740. This work provided cost-effectivenss data in different populations. CrossRefPubMedPubMedCentral
51.
Klein R. Screening interval for retinopathy in type 2 diabetes. Lancet. 2003;361(9353):190–1.CrossRefPubMed
52.
Leese GP. Should diabetes retinal screening intervals change? Diabet Med. 2013;30(1):43–5.CrossRefPubMed
53.
Yeo S, Edwards R, Luzio S, Charles J, Thomas R, Peters J, et al. Diabetic retinopathy screening: perspectives of people with diabetes, screening intervals and costs of attending screening. Diabet Med. 2012;29(7):878–85.CrossRefPubMed
54.
Yeo S, Edwards R, Fargher E, Luzio S, Thomas R, Owens D. Preferences of people with diabetes for diabetic retinopathy screening: a discrete choice experiment. Diabet Med. 2012;29(7):869–77.CrossRefPubMed
55.
Echouffo-Tcheugui JB, Ali MK, Roglic G, Hayward RA, Venkat Narayan KM. Screening intervals for diabetic retinopathy and incidence of visual loss: a systematic review. Diabet Med. 2013;
56.
Taylor-Phillips S, Mistry H, Leslie R, Todkill D, Tsertsvadze A, Connock M, et al. Extending the diabetic retinopathy screening interval beyond 1 year: systematic review. Br J Ophthalmol. 2016;100(1):105–14. https://​doi.​org/​10.​1136/​bjophthalmol-2014-305938.CrossRefPubMed
57.
NSC. The UK NSC recommendations on Diabetic Retinopathy screening in adults. 2016. https://​legacyscreening.​phe.​org.​uk/​diabeticretinopa​thy. Accessed 10/04/2016.
58.
Appelbe D, Broadbent D, Mobayen-Rahni M, Eleuteri A, Bennett A, Moitt T, et al. Introducing personalised risk based intervals in screening for diabetic retinopathy: development, implementation and assessment of safety, cost-effectiveness and patient experience (ISDR): a case study in the use of automated systems in trials. Trials. 2015;16(Suppl 2):O59. 3rd International Clinical Trials Methodology Conference, Glasgow, UK.CrossRefPubMedCentral

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »