Extending diabetic retinopathy screening intervals may be safe for low-risk individuals
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Key takeaways:
- Longer screening intervals of 3 to 5 years may be acceptable in certain circumstances, including those with type 2 diabetes and no current DR.
- Extending these intervals may reduce health care costs and workload.
Longer diabetic retinopathy screening intervals of 3 to 5 years may be safe under certain circumstances and may reduce health care costs and workload, according to a systematic review published in Acta Ophthalmologica.
“This review summarizes the contemporary evidence on [diabetic retinopathy (DR)] screening intervals, which suggests that extending DR screening beyond two-yearly intervals in certain circumstances, such as in those with no current DR, is associated with a low risk of developing [sight-threatening diabetic retinopathy] or requiring treatment,” Jocelyn J. Drinkwater, PhD, of the University of Western Australia and Lions Eye Institute, and colleagues wrote.
Seeking to determine whether annual screening intervals could be lengthened without progression to vison loss, Drinkwater and colleagues reviewed studies that evaluated specific DR screening intervals, identified optimal intervals and examined personalized DR risk assessment.
Researchers identified 23 studies, eight of which were included. Of four studies that assessed specific screening intervals, results suggested a low risk for developing treatable DR within 3 to 4 years for people with type 2 diabetes and no current DR.
After reviewing studies on optimal screening intervals, researchers found that screening intervals of 2 to 3 years appeared safe for individuals without DR but also determined that intervals could safely be extended when other clinical parameters were under control.
Lastly, when evaluating studies on DR risk equations, including RetinaRisk and the Liverpool Risk Calculation Engine, researchers reported that screening intervals could be extended up to 5 years for individuals at lower risk for DR progression, while those at higher risk for progression to sight-threatening DR required more frequent screening.
Taken together, the studies suggested that longer screening intervals of 3 to 5 years appeared safe in certain circumstances, such as patients with type 2 diabetes and no current DR, and patients who had optimal management of other risk factors, like HbA1c and blood pressure.
“Extending DR intervals for those at low risk or using a personalized DR risk assessment has been shown to reduce health care costs and workload, reducing pressure on health services,” Drinkwater and colleagues wrote. “Health departments should consider extending DR screening intervals for those with no current DR and type 2 diabetes, or using a personalized DR risk assessment to improve the efficiency of DR screening and reduce health service costs while maintaining safe outcomes.”
They continued, “Furthermore, for those with current DR, more frequent screening may be appropriate.”
Perspective
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Diabetes is a global epidemic with the estimated prevalence dramatically rising worldwide. Consequently, as the demand for health care increases, it is becoming extremely difficult to ensure adequate access to health care, including screening for diabetic retinopathy in the eyecare setting.
It has been proposed that personalizing diabetic retinopathy screening intervals may improve access to health care by allowing those with higher risk to be screened more frequently. Identifying specific patient groups, such as those with type 2 diabetes and no current diabetic retinopathy, and extending their diabetic retinopathy screening beyond two-yearly intervals has been shown to be acceptable.
Similarly, shorter screening intervals would be suitable for those with a higher risk of progression, such as those with baseline diabetic retinopathy or type 1 diabetes. This in turn may allow access without compromising the care given to those with lower risk.
A limitation of this study was that it did not assess patient adherence or the impact on health care costs.
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