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When Should Screening Be Done for Visual Loss?

Jul 11, 2013

Whether the patient has pre-existing diabetic retinopathy or not should determine the interval for screening….

"A 2-year screening interval for people with no sight-threatening diabetic retinopathy at diagnosis may be safely adopted. For patients with pre-existing diabetic retinopathy, a shorter interval of ≤ 1 year is warranted."

It’s imperative diabetic patients screen for retinopathy to help to prevent blindness and eye complications. Currently there is no evidence regarding the frequency of screening for the best preventative practice.

The goal in this study was to determine the appropriate frequency of eye screening to minimize diabetic related eye complications. The design for this study was a systematic review which included real-world screening program evaluations, studies modeling the natural history of diabetic retinopathy and cost-effectiveness studies assessing the incidence/prevalence of sight-threatening diabetic retinopathy in relation to screening frequency.

The authors included 25 studies in the final systematic review to draw a conclusion for the most effective eye screening frequency. In evaluations of diabetic retinopathy screening programs, the appropriate screening interval ranged from 1 to 4 years in people with no retinopathy at baseline. Despite study heterogeneity, the overall tendency observed in these programs was that 2-year screening intervals among people with no diabetic retinopathy at diagnosis were not associated with high incidence of sight-threatening diabetic retinopathy. Modeling studies (non-economic and economic) assessed a range of screening intervals (1–5 years). The aggregated evidence from both the natural history and cost-effectiveness models favors a screening interval greater than 1 year, but less than 2 years. Such an interval would be appropriate, safe and cost-effective for people with no diabetic retinopathy at diagnosis, while screening intervals less than or equal to 1 year would be preferable for people with pre-existing diabetic retinopathy.

Upon conclusion of the systematic study review it was determined that a 2-year screening interval was appropriate for patients with no sight-threatening diabetic retinopathy at diagnosis. However, patients with pre-existing diabetic eye complications a smaller examination interval preferably within 1 year is regarded as the most safe and effective method to reduce the progression and onset of diabetic retinopathy.

Diabetic Medicine, 07/03/2013, Evidence Based Medicine, Review Article