Publication Exclusive: Europe increasingly involved in setting up systematic screening programs for diabetes

Since the 2005 Liverpool Declaration, Europe has made significant progress toward implementation of systematic national screening programs to reduce diabetes-related visual impairment. However, barriers still remain in countries with predominantly private, insurance-based health care systems or countries that lack human and financial resources, Simon Harding, FRCS, FRCOphth, MD, chair professor of Clinical Ophthalmology at the University of Liverpool and St. Paul’s Eye Unit, Royal Liverpool University Hospital, United Kingdom, said.

Simon Harding

The Liverpool Declaration was the result of a consensus conference, gathering official national representatives of 29 European countries, invited experts and health professionals with expertise in the field of diabetes and diabetic retinopathy. It revised and updated the previous 1989 St. Vincent Declaration, setting the targets and strategies for reduction of diabetes-related visual impairment. Aims to achieve by 2010 included systematic screening programs reaching at least 80% of the population with diabetes, increased availability of trained specialists and universal access to therapy. Two meetings followed in 2008 and 2011 in Amsterdam and Gdansk to review progress and set new targets. The next meeting will be held on June 23 in Manchester.

“We are looking forward to seeing how much progress has been made over 10 years,” Harding said.

Progress since 2005

Since 2005, most countries have progressed significantly along the pathway of a national systematic screening program, although speeds of progress are different.

“It’s a four-step pathway that starts from establishing access to treatment to setting up local systematic screening programs and then moving to regional and to national,” Harding said.

Some countries, he said, have already reached the goal, including Iceland, England, Scotland, Wales, Sweden, Norway, Denmark and the Netherlands.

“These countries have well-established, centralized public health systems. They all moved from 2005 when nothing was in place to having very good nationwide screening programs. Iceland had a successful program already in place in 2005 and reported significant improvement in vision loss but is struggling against the government’s threat to discontinue funding,” Harding said.

Several east European states, where health care is centralized but resources are fewer, such as the Czech Republic, Hungary, Poland, Serbia and Turkey, have been able to establish city-wide or regional screening programs, moving along the local to regional to national pathway.

“Though funding and lack of equipment are challenges, screening programs are more likely delivered here than in wealthier countries with a fragmented, predominantly private, insurance-based system,” Harding said.

Germany, for instance, despite a high level of skills and resources, faces huge organizational challenges and has failed to develop engagement between health insurers, ophthalmologists and regional governments. France, although health authorities have issued guidelines recommending an annual eye screening for people with diabetes, is unable to meet the challenge due to a shortage of ophthalmologists. Spain has only one screening program in place in the Canary Islands, where the diabetes rate is particularly high.

A notable exception is Eire, a state with a predominantly private health system and providers who had previously been reluctant to invest in systematic screening. The government has achieved an agreement with private insurers to restrict funding and access to care to a limited number of specialized centers with systematic screening included. The program was introduced last year and has been successful. Portugal is another positive example where access to treatment is good; a screening program was introduced 1 year ago across the northern part of the country.

Click here to read the full publication exclusive, The Global Notebook, published in Ocular Surgery News Europe Edition, February 2016.