Issue 139 Item 5 Less Frequent Eye Exams May Be Indicated for Some Diabetics

Screening intervals to be lengthened to 2 or 3 years in the 70% of diabetic people with no retinopathy Many people with type 2 diabetes could go longer between screens for retinopathy, according to a report published in the January 18th issue of The Lancet.

Results from the study, which involved more than 7500 patients with type 2 diabetes, suggest that many type 2 diabetics with no signs of retinopathy on one exam could go up to 3 years before needing another exam.

The evidence is sufficiently strong to allow screening intervals to be lengthened to 2 or 3 years in the 70% of diabetic people with no retinopathy," said study author Dr. Simon P. Harding, of Royal Liverpool University Hospital.

However, others say it is too soon to revise guidelines that call for routine yearly tests for diabetic retinopathy–which include the recommendations of the American Diabetes Association.

Worldwide, there is no consensus on how often people with diabetes should be screened for retinopathy. In the US, experts recommend screening be conducted at least annually. The European Retinopathy Working Party recommends exams at least every 2 years, and at least yearly after the first signs of retinopathy.

Existing guidelines are based on expert opinion rather than "direct evidence," the researchers note.

However, they add that patients on insulin and those who have had diabetes for more than 20 years appear to need yearly screening. Over the study period, these patients had elevated rates of retinopathy, even when their initial tests showed no signs of the disorder.

Dr. Harding and his colleagues also advise that diabetics with mild preproliferative retinopathy be screened every 4 months. Lancet 2003;361:195-200