Risk stratification may reduce demand for diabetic retinal screening
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KOLOA, Hawaii — Stratifying patients based on risk factors could help address the demand for more diabetic retinal screening, according to a speaker at Retina 2023.
Robin A. Vora, MD, said the demand for retinal screening services has increased since screening resumed after the COVID-19 pandemic.
“It’s going to be an enormous challenge for physicians to manage all of these patients,” he said. “How do we balance high demand and a low supply of people to provide these services?”
Vora said there are a few options to address the demand side of the problem. One is to screen less often. The current preferred practice is to conduct follow-up screening once a year. Although some studies have shown that screening every other year is feasible, Vora said many physicians find it hard to go against preferred practice guidelines.
The more likely solution, Vora said, is to use risk stratification to screen more intelligently.
“We know that at any given time, over 85% of patients screen no or mild retinopathy and require no treatment,” he said. “These patients are flooding our clinics, flooding our cameras, and they’re normal. How do we improve our hit rate?”
By using machine learning to identify risks such as HbA1c, blood pressure and retinopathy grade, Vora said it is possible to capture 90% of proliferative diabetic retinopathy cases while screening just 50% of the population.
While addressing the shortage of providers will be difficult, Vora said increasing the number of cameras could be a good supply-side solution. That could mean screening patients in places such as primary care offices, pharmacies or vaccination centers.
“The future of diabetic screening will be evidence-based screening, screening those based on individual risk, putting cameras literally everywhere and using artificial intelligence support,” Vora said.
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Vora RA, et al. Diabetic retinal screening: 2023 and beyond. Presented at: Retina 2023; Jan. 15-20, 2023; Koloa, Hawaii.
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